Provider Demographics
NPI:1174859755
Name:HINES, TAMEKA DENISE (RN)
Entity Type:Individual
Prefix:
First Name:TAMEKA
Middle Name:DENISE
Last Name:HINES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TAMEKA
Other - Middle Name:D
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:5027 YALECREST DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-8353
Mailing Address - Country:US
Mailing Address - Phone:937-674-5668
Mailing Address - Fax:937-522-0367
Practice Address - Street 1:5027 YALECREST DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-8353
Practice Address - Country:US
Practice Address - Phone:937-674-5668
Practice Address - Fax:937-522-0367
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-02
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN449811163W00000X
OHPN125711164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse