Provider Demographics
NPI:1184390775
Name:TICE, IAN
Entity type:Individual
Prefix:MR
First Name:IAN
Middle Name:
Last Name:TICE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 FRANKLIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:TORONTO
Mailing Address - State:OH
Mailing Address - Zip Code:43964-1153
Mailing Address - Country:US
Mailing Address - Phone:740-730-0305
Mailing Address - Fax:
Practice Address - Street 1:1007 FRANKLIN ST STE A
Practice Address - Street 2:
Practice Address - City:TORONTO
Practice Address - State:OH
Practice Address - Zip Code:43964-1153
Practice Address - Country:US
Practice Address - Phone:740-730-0305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.347647163WG0000X
OHAPRN.CNP.0029614363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice