Individual
JOHNNY R TICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
115 HARPER COURT, TUSCALOOSA, AL 35401-1250
(205) 366-3010
(205) 366-3012
Mailing address
PO BOX 21231, TISCA;PPSA, AL 35401
(205) 366-3010
(205) 366-3012
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
1-123152
AL
363L00000X
Nurse Practitioner
271591
NC
363LF0000X
Family Nurse Practitioner
5007244
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1164825923
—
NC
Enumeration date
10/07/2014
Last updated
11/22/2023
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