Provider Demographics
NPI:1760880009
Name:TUNNINGLEY, OCTAVIA ALEXIS (NP)
Entity Type:Individual
Prefix:
First Name:OCTAVIA
Middle Name:ALEXIS
Last Name:TUNNINGLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:OCTAVIA
Other - Middle Name:ALEXIS
Other - Last Name:KABOBEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3333 BURNET AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-636-4266
Mailing Address - Fax:513-636-3549
Practice Address - Street 1:3333 BURNET AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-636-4266
Practice Address - Fax:513-636-3549
Is Sole Proprietor?:No
Enumeration Date:2014-12-19
Last Update Date:2023-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.16938-NP363LP0200X
OHAPRN.CNP.16938363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics