Individual
LISA ASHLEY TICHENOR
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
5731 BEE RIDGE ROAD, SARASOTA, FL 34233
(941) 342-1100
Mailing address
8390 CHAMPIONS GATE BOULEVARD, SUITE 306, CHAMPIONS GATE, FL 33896
(407) 390-1677
(407) 390-1765
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
OS7661
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
56739
BCBS
FL
Enumeration date
03/20/2006
Last updated
07/08/2007
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