Provider Demographics
NPI:1558068510
Name:COFFEY, TYLAJA Z
Entity Type:Individual
Prefix:
First Name:TYLAJA
Middle Name:Z
Last Name:COFFEY
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 1:21105 HANSEN RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44137-2012
Mailing Address - Country:US
Mailing Address - Phone:330-338-3103
Mailing Address - Fax:
Practice Address - Street 1:21105 HANSEN RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44137-2012
Practice Address - Country:US
Practice Address - Phone:330-338-3103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health