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General NPI Number Information
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NPI Number | 1578326187
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Entity Type | Individual
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Provider Name | TYKEILA IESHIA TISDALE BSHA, MHA, CD
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Gender | Female
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Dates
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Enumeration Date | 02/05/2024
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Last Update Date | 06/16/2025
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Provider Practice Location Address
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Address Line | 17929 HUNTING BOW CIR
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City | LUTZ
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State | FL
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Zip | 33558-5378
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Country | US
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Telephone | 813-399-4833
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Fax |
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Provider Business Mailing Address
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Address Line | 9980 HOUND CHASE DR
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City | GIBSONTON
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State | FL
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Zip | 33534-5422
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Country | US
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Telephone | 813-399-4833
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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