Provider Demographics
NPI:1306207733
Name:NELSON, TIA-MONIQUE F (MSN, FP-APRN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:TIA-MONIQUE
Middle Name:F
Last Name:NELSON
Suffix:
Gender:F
Credentials:MSN, FP-APRN, FNP-C
Other - Prefix:MS
Other - First Name:TIA-MONIQUE
Other - Middle Name:FAITH
Other - Last Name:BLASH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, APN, FNP-C
Mailing Address - Street 1:9977 WOODS DR
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1057
Mailing Address - Country:US
Mailing Address - Phone:224-364-2273
Mailing Address - Fax:
Practice Address - Street 1:9977 WOODS DR
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1057
Practice Address - Country:US
Practice Address - Phone:224-364-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-12
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014008363L00000X
IL277.001548363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner