Provider Demographics
NPI:1861919086
Name:PERREIRA, TISHA MARIE I (APRN CNP021231)
Entity type:Individual
Prefix:
First Name:TISHA
Middle Name:MARIE
Last Name:PERREIRA
Suffix:I
Gender:F
Credentials:APRN CNP021231
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:457 WOODVIEW RD
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-3050
Mailing Address - Country:US
Mailing Address - Phone:614-282-6344
Mailing Address - Fax:
Practice Address - Street 1:457 WOODVIEW RD
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-3050
Practice Address - Country:US
Practice Address - Phone:614-282-6344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-28
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH021231363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner