Provider Demographics
NPI:1275890725
Name:KOMOROWSKI, TINA MARIA (LPN)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:MARIA
Last Name:KOMOROWSKI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 E 345TH ST
Mailing Address - Street 2:
Mailing Address - City:EASTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44095-2416
Mailing Address - Country:US
Mailing Address - Phone:440-946-2707
Mailing Address - Fax:
Practice Address - Street 1:730 E 345TH ST
Practice Address - Street 2:
Practice Address - City:EASTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44095-2416
Practice Address - Country:US
Practice Address - Phone:440-946-2707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-20
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH148328-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse