Stephanie Jean Tisdal, MSN, A-GNP-C

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

5011137 Issued in NC

Practice address

1824 Hillandale Rd
Durham, NC 27705-2650

Phone

(919) 383-6107

NPI assigned

Oct 19, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1539907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539907200000",
    "number": "1477029163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8705 BRANDON STATION RD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276134307",
            "telephone_number": "479-462-5186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1824 HILLANDALE RD",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277052650",
            "telephone_number": "919-383-6107"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "508 Fulton St",
            "address_purpose": "LOCATION",
            "city": "Durham",
            "state": "NC",
            "postal_code": "277053875",
            "country_code": "US",
            "telephone_number": "919-286-0411",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TISDAL",
        "first_name": "STEPHANIE",
        "middle_name": "JEAN",
        "name_prefix": "Mrs.",
        "credential": "MSN, A-GNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-19",
        "last_updated": "2018-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5011137",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sherwin Charng-Shiow Ting, M.D.
• Qionna Mariel Tinney, M.D.
• Sarah Tintle, PT
• Kevin Matthew Tirado Roman
• Jessica S Tischner, PH.D.
• Grace Naa Ayorkor Tisdale, MD
• Kathleen Marie Tise, LCSW
• James Franklin Titch, CRNA
• Krystal Strand Titus-Rains, PHARMD
• TLC Adult Group Home

• Nurse Practitioner in Durham, NC
• Providers in Durham, NC by specialty
• Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.