Provider Demographics
NPI:1881893311
Name:ERVIN, TOMIKA JEANELLE (LPN)
Entity type:Individual
Prefix:MRS
First Name:TOMIKA
Middle Name:JEANELLE
Last Name:ERVIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:TOMIKA
Other - Middle Name:JEANELLE
Other - Last Name:YARBROUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:1275 ROSLYN AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-3424
Mailing Address - Country:US
Mailing Address - Phone:330-869-5042
Mailing Address - Fax:
Practice Address - Street 1:1275 ROSLYN AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-3424
Practice Address - Country:US
Practice Address - Phone:330-869-5042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-14
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN109095164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse