Individual
JENNIFER NICOLE TISDALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
7401 GRANBY ST, NORFOLK, VA 23505-3406
(757) 388-9925
(757) 965-8519
Mailing address
7401 GRANBY ST, NORFOLK, VA 23505-3406
(757) 388-9925
(757) 965-8519
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
Primary
0110006241
VA
Other
Enumeration date
06/09/2018
Last updated
10/03/2024
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