Provider Demographics
NPI:1982361689
Name:REYNOLDS, TAMIKA L (STNA)
Entity Type:Individual
Prefix:MS
First Name:TAMIKA
Middle Name:L
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1059 WHITTIER AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-2049
Mailing Address - Country:US
Mailing Address - Phone:330-906-0336
Mailing Address - Fax:
Practice Address - Street 1:1059 WHITTIER AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-2049
Practice Address - Country:US
Practice Address - Phone:330-906-0336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH402250120220376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH402250120220OtherOHIO DEPARTMENT OF HEALTH