LACY REBAKA TISDALE

JACKSON, TN
NPI1033517768
Former NameLACY THOMAS
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy363LF0000X Nurse Practitioner Family
(Licence: TN  25492)
Additional Taxonomies363LF0000X Nurse Practitioner Family
(Licence: AR  A004241)
Enumeration Date2014-12-11
Last Update Date2021-04-09
Business Address
LACY REBAKA TISDALE NP-C
2054 S HIGHLAND AVE
JACKSON, TN 38301-7741
Phone number: 731-499-8708
Mailing Address
LACY REBAKA TISDALE NP-C
42 CABIN CREEK DIRVE
JACKSON, TN 38305
Phone number: 870-413-2203