Provider Demographics
NPI:1376126193
Name:NEWBERRY, TIERRA SHONTAI (RN)
Entity Type:Individual
Prefix:
First Name:TIERRA
Middle Name:SHONTAI
Last Name:NEWBERRY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 E COMANCHE AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-4512
Mailing Address - Country:US
Mailing Address - Phone:813-955-4749
Mailing Address - Fax:
Practice Address - Street 1:3020 E COMANCHE AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-4512
Practice Address - Country:US
Practice Address - Phone:813-955-4749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9420848163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse