Basic Information
| Provider Information | |||||||||
| NPI: | 1174702351 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARZYK | ||||||||
| FirstName: | TISHA | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DNP, AGACNP-BC, CWS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3005 AMBROSE AVE | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372074709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8446736968 | ||||||||
| FaxNumber: | 8446736968 | ||||||||
| Practice Location | |||||||||
| Address1: | 3005 AMBROSE AVE | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372074709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8446736968 | ||||||||
| FaxNumber: | 8446736968 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2007 | ||||||||
| LastUpdateDate: | 10/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 09/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | 12996 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 174400000X | N | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 3341511 | 05 | TN | MEDICAID |