Provider Demographics
NPI:1407419252
Name:PRIESTER, TIARA (CNA)
Entity Type:Individual
Prefix:
First Name:TIARA
Middle Name:
Last Name:PRIESTER
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 WEST 26TH STREET RIVIERA BEACH,FL
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33404
Mailing Address - Country:US
Mailing Address - Phone:561-337-0815
Mailing Address - Fax:
Practice Address - Street 1:1625 WEST 26TH STREET RIVIERA BEACH,FL
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404
Practice Address - Country:US
Practice Address - Phone:561-337-0815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-17
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL294303376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide