Provider Demographics
NPI:1437904992
Name:NEARS, TYISKA
Entity Type:Individual
Prefix:
First Name:TYISKA
Middle Name:
Last Name:NEARS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 AQUA VISTA LN
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77469-5057
Mailing Address - Country:US
Mailing Address - Phone:281-505-4640
Mailing Address - Fax:
Practice Address - Street 1:1118 AQUA VISTA LN
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77469-5057
Practice Address - Country:US
Practice Address - Phone:281-505-4640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home