Provider Demographics
NPI:1093430779
Name:COOPER, TIANA N (STNA)
Entity Type:Individual
Prefix:
First Name:TIANA
Middle Name:N
Last Name:COOPER
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 1:3838 WASHINGTON AVE APT 16
Mailing Address - Street 2:
Mailing Address - City:CHEVIOT
Mailing Address - State:OH
Mailing Address - Zip Code:45211-4649
Mailing Address - Country:US
Mailing Address - Phone:513-227-9828
Mailing Address - Fax:
Practice Address - Street 1:3838 WASHINGTON AVE APT 16
Practice Address - Street 2:
Practice Address - City:CHEVIOT
Practice Address - State:OH
Practice Address - Zip Code:45211-4649
Practice Address - Country:US
Practice Address - Phone:513-227-7546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-05
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.184732.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse