Provider Demographics
NPI:1104276419
Name:JONES, TYESHIA (NP-C, RNFA)
Entity type:Individual
Prefix:
First Name:TYESHIA
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:NP-C, RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 TERMINO AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-2128
Mailing Address - Country:US
Mailing Address - Phone:562-817-5602
Mailing Address - Fax:562-817-5605
Practice Address - Street 1:1703 TERMINO AVE STE 207
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804
Practice Address - Country:US
Practice Address - Phone:562-817-5602
Practice Address - Fax:562-817-5605
Is Sole Proprietor?:No
Enumeration Date:2016-06-16
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95002786363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner