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General NPI Number Information
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NPI Number | 1326778333
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Entity Type | Individual
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Provider Name | CHRISMARTHE TISMA RN, LNC, CFN
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Gender | Female
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Dates
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Enumeration Date | 06/13/2022
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Last Update Date | 06/13/2022
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Provider Practice Location Address
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Address Line | 12411 NW MCGREGOR LN
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City | PORT ST LUCIE
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State | FL
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Zip | 34987-3056
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Country | US
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Telephone | 561-541-7972
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Fax |
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Provider Business Mailing Address
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Address Line | 12411 NW MCGREGOR LN
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City | PORT ST LUCIE
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State | FL
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Zip | 34987-3056
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Country | US
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Telephone | 561-541-7972
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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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 | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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