Provider Demographics
NPI:1912872078
Name:FLUELLEN, TIARAH
Entity type:Individual
Prefix:
First Name:TIARAH
Middle Name:
Last Name:FLUELLEN
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 E 13TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:CRUM LYNNE
Mailing Address - State:PA
Mailing Address - Zip Code:19022-1342
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 632
Practice Address - Street 2:
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-0632
Practice Address - Country:US
Practice Address - Phone:856-952-0773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-08
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN306173164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse