Provider Demographics
NPI:1518608280
Name:JENNINGS, TONIQUA D
Entity Type:Individual
Prefix:
First Name:TONIQUA
Middle Name:D
Last Name:JENNINGS
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 1:4786 DRESSLER RD NW # 318
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2555
Mailing Address - Country:US
Mailing Address - Phone:234-521-0822
Mailing Address - Fax:
Practice Address - Street 1:1027 SHERRICK RD SE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44707-3506
Practice Address - Country:US
Practice Address - Phone:330-313-0270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No251E00000XAgenciesHome Health