Provider Demographics
NPI:1689210734
Name:COLLIER, TANJA
Entity Type:Individual
Prefix:
First Name:TANJA
Middle Name:
Last Name:COLLIER
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 1:925 KEYNOTE CIR STE 300
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44131-1869
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:925 KEYNOTE CIR STE 300
Practice Address - Street 2:
Practice Address - City:BROOKLYN HTS
Practice Address - State:OH
Practice Address - Zip Code:44131-1869
Practice Address - Country:US
Practice Address - Phone:216-931-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN240868163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health