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General NPI Number Information
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NPI Number | 1538289996
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Entity Type | Individual
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Provider Name | TISHA FOSTER M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3200 LAKELAND HILLS BLVD
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City | LAKELAND
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State | FL
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Zip | 33805-2271
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Country | US
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Telephone | 863-687-8925
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Fax |
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Provider Business Mailing Address
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Address Line | 300 MAGNETA LOOP
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City | AUBURNDALE
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State | FL
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Zip | 33823-9790
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Country | US
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Telephone |
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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 | 207ZB0001X
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Taxonomy Name | Blood Banking & Transfusion Medicine Physician
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License Number | 95945
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License Number State | FL
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