Provider Demographics
NPI:1215575220
Name:WRIGHT, TIANA M
Entity Type:Individual
Prefix:
First Name:TIANA
Middle Name:M
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 PROFESSIONAL PL W STE A103
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-3632
Mailing Address - Country:US
Mailing Address - Phone:757-816-7063
Mailing Address - Fax:
Practice Address - Street 1:809 PROFESSIONAL PL W STE A103
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3632
Practice Address - Country:US
Practice Address - Phone:757-816-7063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-20
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-202215251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1265074850Medicaid