Healthcare Provider Details

I. General information

NPI: 1194138370
Provider Name (Legal Business Name): TISHA NIKOLE ARCHER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TISHA NIKOLE WARDRIP CNP

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 FOREST AVE SUITE 202
ZANESVILLE OH
43701-2868
US

IV. Provider business mailing address

945 BETHESDA DR SUITE 200
ZANESVILLE OH
43701-0801
US

V. Phone/Fax

Practice location:
  • Phone: 740-588-9120
  • Fax: 740-588-9140
Mailing address:
  • Phone: 740-454-4788
  • Fax: 740-450-6157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA16026-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: