Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

MS. Peta-Gaye Tisha Gordon

Individual provider Licensed Practical Nurse · NPI 1053645341

MS. Peta-Gaye Tisha Gordon is a Licensed Practical Nurse in Medford, New York. Practices as a sole proprietor. Licensed in New York.

Licensed in
NY
In the registry since
2009
Specialties on file
2

Practice location Address checks out

127 Maple Ln
Medford, NY 11763-1027
Phone: (631) 576-5833
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Registered Nurse (primary) Taxonomy 163W00000X · Licence 629991 (NY)
Licensed Practical Nurse Taxonomy 164W00000X · Licence 279643-1 (NY)

Record details

NPI number1053645341
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedSeptember 20, 2009
Last updated in NPPESApril 15, 2024
Certification dateApril 15, 2024

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