MEDICARE: TIA ROBERTSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	F01231486	WI

General Provider Information

NPI Number	:	1831049865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIA ROBERTSON

Provider Business Mailing Address
First Line	:	4747 N 44TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53218-5204
Country	:	US
Telephone Number	:	414-839-0319
Fax Number	:

Provider Business Practice Location Address
First Line	:	4747 N 44TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53218-5204
Country	:	US
Telephone Number	:	414-839-0319
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2026
Last Update Date	:	01/29/2026

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Directions to “ TIA ROBERTSON ” Practice Location

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