Most Relevant Information
Provider Data
| NPI Number: | 1003481607 |
| Provider Name: | TISHEILA DIANE WHITTED APRN, FNP-BC |
| Entity Type: | Individual |
| Taxonomy Code: | 363L00000X |
| Specialty: | Nurse Practitioner |
| License Number: | 24754 |
Most Important Dates
| Enumeration Date: | 05/25/2021 |
| Last Updated: | 01/15/2024 |
Provider Practice Location
2720 SUNSET BLVD
WEST COLUMBIA
SC
291694810
Practice Location Phone/Fax
| Phone: | 8037912480 |
| Fax: | 8039364102 |
Provider Mailing Location
PO BOX 6069
WEST COLUMBIA
SC
291716069
Provider Mailing Phone/Fax
| Phone: | 8037912480 |
| Fax: | 8039364102 |