Provider Demographics
NPI:1700404845
Name:PORCHIA, TYRONIA PATRICIA
Entity Type:Individual
Prefix:MS
First Name:TYRONIA
Middle Name:PATRICIA
Last Name:PORCHIA
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TYRONIA
Other - Middle Name:PATRICIA
Other - Last Name:PORCHIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8911 RAMONA AVE # 89
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63121-4018
Mailing Address - Country:US
Mailing Address - Phone:909-261-3949
Mailing Address - Fax:
Practice Address - Street 1:8911 RAMONA AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63121-4018
Practice Address - Country:US
Practice Address - Phone:909-261-3949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLC9927162374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide