Provider Demographics
NPI:1790526440
Name:HAKIM, TIERRA S (LPN)
Entity type:Individual
Prefix:
First Name:TIERRA
Middle Name:S
Last Name:HAKIM
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25165 RANDOLPH RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44146-3952
Mailing Address - Country:US
Mailing Address - Phone:216-509-8992
Mailing Address - Fax:
Practice Address - Street 1:25165 RANDOLPH RD
Practice Address - Street 2:
Practice Address - City:BEDFORD HTS
Practice Address - State:OH
Practice Address - Zip Code:44146-3952
Practice Address - Country:US
Practice Address - Phone:216-509-8992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH188586164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse