person
Lacy Rebaka Tisdale, NP-C
Family Nurse Practitioner in Jackson, Tennessee
NPI 1033517768

Lacy Rebaka Tisdale is a Family Nurse Practitioner based in Jackson, TN and is specialized in Family. Lacy Rebaka Tisdale practices in Jackson, TN and has the professional credentials of NP-C. The NPI Number for Lacy Rebaka Tisdale is 1033517768 and holds a License No. A004241 (Tennessee).

The current practice location address for Lacy Rebaka Tisdale is 2054 S Highland Ave, Jackson, TN and can be reached out via phone at 731-499-8708 and via fax at 731-499-8709.

Location: 2054 S Highland Ave, Jackson, TN, 38305
person
Provider Profile Details
NPI Number
1033517768
Provider Name
Lacy Rebaka Tisdale
Credential
NP-C
Provider Entity Type
Individual
Gender
Female
Address
2054 S Highland Ave, Jackson, TN, 38305
Phone Number
731-499-8708
Fax Number
731-499-8709
Provider Enumeration Date
12/11/2014
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
2054 S Highland Ave
City
State
Zip
38301-7741
Phone Number
731-499-8708
Fax Number
731-499-8709
person
Provider Business Mailing Address Details
Address
2054 S Highland Ave
City
State
Zip
38301-7741
Phone Number
731-499-8708
Fax Number
731-499-8709
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
Family
Taxonomy
License No.
A004241 (Arkansas)
Definition
Definition to come...
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