Provider Demographics
NPI:1285528257
Name:WITTY, TISHA (CNA)
Entity type:Individual
Prefix:
First Name:TISHA
Middle Name:
Last Name:WITTY
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 W LAKE MARY BLVD STE 1010
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2449
Mailing Address - Country:US
Mailing Address - Phone:321-202-9798
Mailing Address - Fax:
Practice Address - Street 1:4300 W LAKE MARY BLVD STE 1010
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2449
Practice Address - Country:US
Practice Address - Phone:321-202-9798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA44093372600000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
No372600000XNursing Service Related ProvidersAdult Companion