MEDICARE: FELESHIA BYTHWOOD TISSIERA LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	PN0958431	FL

General Provider Information

NPI Number	:	1558874545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FELESHIA BYTHWOOD TISSIERA LPN

Provider Business Mailing Address
First Line	:	2608 AVENUE M
Second Line	:
City	:	RIVIERA BEACH
State	:	FL
Zip	:	33404-4159
Country	:	US
Telephone Number	:	561-352-3192
Fax Number	:	561-842-8557

Provider Business Practice Location Address
First Line	:	2608 AVENUE M
Second Line	:
City	:	RIVIERA BEACH
State	:	FL
Zip	:	33404-4159
Country	:	US
Telephone Number	:	561-352-3192
Fax Number	:	561-842-8557

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2017
Last Update Date	:	07/21/2022

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