Provider Demographics
NPI:1952119737
Name:TISDALE, SABRINA MICHELLE (HEALTHCARE PROVIDER)
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:MICHELLE
Last Name:TISDALE
Suffix:
Gender:F
Credentials:HEALTHCARE PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 VERNON ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-2142
Mailing Address - Country:US
Mailing Address - Phone:800-468-7834
Mailing Address - Fax:800-468-7834
Practice Address - Street 1:1513 S WASHINGTON AVE APT B
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-2145
Practice Address - Country:US
Practice Address - Phone:800-468-7834
Practice Address - Fax:800-468-7834
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-25
Last Update Date:2024-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide