Provider Demographics
NPI:1194138370
Name:ARCHER, TISHA NIKOLE (CNP)
Entity type:Individual
Prefix:
First Name:TISHA
Middle Name:NIKOLE
Last Name:ARCHER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:TISHA
Other - Middle Name:NIKOLE
Other - Last Name:WARDRIP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:945 BETHESDA DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-0801
Mailing Address - Country:US
Mailing Address - Phone:740-454-4788
Mailing Address - Fax:740-450-6157
Practice Address - Street 1:751 FOREST AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-2868
Practice Address - Country:US
Practice Address - Phone:740-588-9120
Practice Address - Fax:740-588-9140
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-05
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA16026-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily