Angela Sims Tisdale, ARNP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

9464937 Issued in FL

Practice address

6804 Cecelia Dr
New Port Richey, FL 34653-4935

Phone

(855) 232-0644

Fax

(888) 546-0488

NPI assigned

Dec 6, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

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

Specialty

Nurse Practitioner

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Suncoast Community Health Centers IncGroup PAC ID 3870402548, 30 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Suncoast Community Health Centers Inc

  • Federally Qualified Health Center (FQHC)
  • Ruskin, FL
  • NPI 1285644799
  Medicare reassignment Care Compare group NPD
• Suncoast Community Health Centers, Inc

  • Federally Qualified Health Center (FQHC)
  • Wimauma, FL
  • NPI 1518388354
  NPD
• Suncoast Community Health Centers Inc

  • Federally Qualified Health Center (FQHC)
  • Ruskin, FL
  • NPI 1104836600
  NPD (past)

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

{
    "created_epoch": "1512518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646352000000",
    "number": "1508371014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6804 CECELIA DR",
            "city": "NEW PORT RICHEY",
            "state": "FL",
            "postal_code": "346534935",
            "telephone_number": "855-232-0644",
            "fax_number": "888-546-0488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6804 CECELIA DR",
            "city": "NEW PORT RICHEY",
            "state": "FL",
            "postal_code": "346534935",
            "telephone_number": "855-232-0644",
            "fax_number": "888-546-0488"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10203 Majestic Palm Cir Apt 102",
            "address_purpose": "LOCATION",
            "city": "Riverview",
            "state": "FL",
            "postal_code": "335789440",
            "country_code": "US",
            "telephone_number": "251-455-4464",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TISDALE",
        "first_name": "ANGELA",
        "middle_name": "SIMS",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-06",
        "last_updated": "2022-03-04",
        "certification_date": "2022-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "FL",
            "license": "9464937",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "FL",
            "license": "9464937",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Adult Health Nurse Practitioner in New Port Richey, FL
• Providers in New Port Richey, FL by specialty
• Adult Health Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.