Provider Demographics
NPI:1942823141
Name:SKINNER, TIA NICOLE (HAIR LOSS SPECIALIST)
Entity Type:Individual
Prefix:
First Name:TIA
Middle Name:NICOLE
Last Name:SKINNER
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64651
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23467-4651
Mailing Address - Country:US
Mailing Address - Phone:757-201-5442
Mailing Address - Fax:
Practice Address - Street 1:5347 LILA LN
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-6783
Practice Address - Country:US
Practice Address - Phone:757-201-5442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty