Provider Demographics
NPI:1235643875
Name:TIPTON, BIANCA NICOLE
Entity Type:Individual
Prefix:
First Name:BIANCA
Middle Name:NICOLE
Last Name:TIPTON
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 1:2820 BOBMEYER RD C- HANGER 7
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45015-4448
Mailing Address - Country:US
Mailing Address - Phone:513-334-8852
Mailing Address - Fax:
Practice Address - Street 1:312 HANCOCK AVE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-4448
Practice Address - Country:US
Practice Address - Phone:513-225-3374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-17
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH822123348Medicaid