Provider Demographics
NPI:1275887390
Name:COMBS, TANYA MARIE (RN)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:MARIE
Last Name:COMBS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TONYA
Other - Middle Name:MARIE
Other - Last Name:COMBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:18205 LIBBY RD
Mailing Address - Street 2:
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-1515
Mailing Address - Country:US
Mailing Address - Phone:216-475-3930
Mailing Address - Fax:
Practice Address - Street 1:18205 LIBBY RD
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-1515
Practice Address - Country:US
Practice Address - Phone:216-475-3930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHR.N.358406163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse