Provider Demographics
NPI:1134818131
Name:CALLIENS, TINIQUA L (CNA)
Entity type:Individual
Prefix:
First Name:TINIQUA
Middle Name:L
Last Name:CALLIENS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10716 MOUNT CARMEL RD APT F10716
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44104-2571
Mailing Address - Country:US
Mailing Address - Phone:216-810-5135
Mailing Address - Fax:
Practice Address - Street 1:10716 MOUNT CARMEL RD APT F10716
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44104-2571
Practice Address - Country:US
Practice Address - Phone:216-810-5135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3651889374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide