Provider Demographics
NPI:1720505159
Name:TYUKODY, JACKI NICHOLE (RN)
Entity Type:Individual
Prefix:MRS
First Name:JACKI
Middle Name:NICHOLE
Last Name:TYUKODY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3287 TOWNLINE RD
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:OH
Mailing Address - Zip Code:44081-9790
Mailing Address - Country:US
Mailing Address - Phone:440-668-0911
Mailing Address - Fax:
Practice Address - Street 1:3287 TOWNLINE RD
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:OH
Practice Address - Zip Code:44081-9790
Practice Address - Country:US
Practice Address - Phone:440-668-0911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.342266163WE0003X, 163WM0705X, 163WP0807X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent