Provider Demographics
NPI:1982291324
Name:HEARN, ANDREA TINILL
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:TINILL
Last Name:HEARN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18905 ARROWHEAD AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44119-2142
Mailing Address - Country:US
Mailing Address - Phone:216-513-3252
Mailing Address - Fax:
Practice Address - Street 1:18905 ARROWHEAD AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44119-2142
Practice Address - Country:US
Practice Address - Phone:216-513-3252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3020180Medicaid