Provider Demographics
NPI:1043713571
Name:NUBY, TIZJAI ALEXIS (STNA)
Entity Type:Individual
Prefix:
First Name:TIZJAI
Middle Name:ALEXIS
Last Name:NUBY
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:568 MILLER ST
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44502-2350
Mailing Address - Country:US
Mailing Address - Phone:330-559-4164
Mailing Address - Fax:
Practice Address - Street 1:568 MILLER ST
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44502-2350
Practice Address - Country:US
Practice Address - Phone:330-559-4164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-11
Last Update Date:2018-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400340330304376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide