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

Tanisha Moore

Individual provider Physician Assistant · NPI 1558069542

Tanisha Moore is a Physician Assistant in Wilmette, Illinois. Practices as a sole proprietor. Licensed in Illinois.

Licensed in
IL
In the registry since
2023

Practice location Address checks out

311A Ridge Rd Apt 113
Wilmette, IL 60091-3256
Phone: (267) 505-6106
Show map & directions

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

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 085-009934 (IL)

Record details

NPI number1558069542
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedFebruary 20, 2023
Last updated in NPPESJuly 23, 2024
Certification dateJuly 23, 2024
Mailing address311a Ridge Rd Apt 113, Wilmette, IL 60091-3256

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