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NPI Code Detail

MEDICARE: CHRISTY TISDALL

MEDICARE: CHRISTY TISDALL
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
1163WP2201XAmbulatory Care Registered NurseRN9642803FL

General Provider Information

NPI Number : 1902730633
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTY TISDALL
Provider Business Mailing Address
First Line : 193 ARUBA LN
Second Line :
City : PONTE VEDRA BEACH
State : FL
Zip : 32082-1606
Country : US
Telephone Number : 904-953-2327
Fax Number : 904-953-0272
Provider Business Practice Location Address
First Line : 4500 SAN PABLO RD S
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32224-1865
Country : US
Telephone Number : 904-953-2327
Fax Number : 904-953-0272
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2026
Last Update Date : 06/09/2026

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Directions to “ CHRISTY TISDALL ” Practice Location

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