Provider Demographics
NPI:1689944019
Name:HART, TIA SHERESS (RN)
Entity Type:Individual
Prefix:MRS
First Name:TIA
Middle Name:SHERESS
Last Name:HART
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:782 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-3341
Mailing Address - Country:US
Mailing Address - Phone:937-823-4955
Mailing Address - Fax:
Practice Address - Street 1:782 E 3RD ST
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-3341
Practice Address - Country:US
Practice Address - Phone:937-823-4955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-02
Last Update Date:2012-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN375057163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health