Nelson, Tiesha Simona

Nelson, Tiesha Simona is an individual health care provider with primary practice located at 8360 W Oakland Park Blvd Ste 303 , Sunrise FL 33351-7339. She recently has 4 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Forensic, Behavioral Health & Social Service Providers / Psychologist. Behavioral Health & Social Service Providers / Psychologist is her primary health care specialty. Nelson, Tiesha Simona can be contacted via phone (954) 546-4677.

Contact Information

Primary practice address
8360 W Oakland Park Blvd Ste 303 Sunrise FL 33351-7339
Phone: (954) 546-4677
Fax: (941) 328-3575
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 103TA0400X PY7781 Florida
Behavioral Health & Social Service Providers / Clinical 103TC0700X PY7781 Florida
Behavioral Health & Social Service Providers / Forensic 103TF0200X PY7781 Florida
Behavioral Health & Social Service Providers / Psychologist 103T00000X PY 7781 Florida

Profile Details

NPI number 1548407919
LBN Legal business name Nelson, Tiesha Simona
Credentials PSY.D.
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 7th, 2009
Last updated Jan 6th, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1548407919 NPPES
Florida MEDICAID 106660500

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