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General NPI Number Information
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NPI Number | 1306594429
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Entity Type | Individual
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Provider Name | TISHEKA LAIDLEY
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Gender | Female
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Dates
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Enumeration Date | 03/17/2022
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 8606 NW 36TH ST # 107
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City | SUNRISE
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State | FL
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Zip | 33351-6665
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Country | US
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Telephone | 163-156-8914
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Fax |
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Provider Business Mailing Address
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Address Line | 5036 ESTONIAN DR
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City | FAIRBURN
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State | GA
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Zip | 30213-2157
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Country | US
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Telephone | 163-156-8914
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 146L00000X
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Taxonomy Name | Paramedic
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | LPN105085
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License Number State | GA
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