Provider Demographics
NPI:1295432367
Name:TAKACS, TINA M
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:TAKACS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TINA
Other - Middle Name:MARIE
Other - Last Name:TAKACS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:TINA M CONNER
Mailing Address - Street 1:5810 BANDY RD
Mailing Address - Street 2:
Mailing Address - City:HOMEWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44634-9730
Mailing Address - Country:US
Mailing Address - Phone:330-268-9661
Mailing Address - Fax:
Practice Address - Street 1:5810 BANDY RD
Practice Address - Street 2:
Practice Address - City:HOMEWORTH
Practice Address - State:OH
Practice Address - Zip Code:44634-9730
Practice Address - Country:US
Practice Address - Phone:330-268-9661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health