Individual
ELIZABETH TISDALE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1061 HARMON AVE, STE 1D03, FORT STEWART, GA 31314-5641
(912) 435-6933
Mailing address
118 MILL CREEK DR, RINCON, GA 31326-5547
(912) 657-2855
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
Primary
RN174473
GA
Other
Enumeration date
08/29/2010
Last updated
08/29/2010
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