Provider Demographics
NPI:1083402853
Name:JIMMERSON, TISHA
Entity type:Individual
Prefix:
First Name:TISHA
Middle Name:
Last Name:JIMMERSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9411 NEBRASKA PLZ APT 204
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68122-1324
Mailing Address - Country:US
Mailing Address - Phone:402-578-4253
Mailing Address - Fax:
Practice Address - Street 1:4139 N 43RD ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68111-2128
Practice Address - Country:US
Practice Address - Phone:531-495-3247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant