Provider Demographics
NPI:1770304248
Name:TUCKER-THOMAS, OTISZ NANIKA (PN)
Entity type:Individual
Prefix:
First Name:OTISZ
Middle Name:NANIKA
Last Name:TUCKER-THOMAS
Suffix:
Gender:F
Credentials:PN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3517 TRIMBLE AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45207-1225
Mailing Address - Country:US
Mailing Address - Phone:513-473-8789
Mailing Address - Fax:
Practice Address - Street 1:3517 TRIMBLE AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45207-1225
Practice Address - Country:US
Practice Address - Phone:513-473-8789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No347C00000XTransportation ServicesPrivate Vehicle
No376K00000XNursing Service Related ProvidersNurse's Aide