Provider Demographics
NPI:1124654959
Name:CRAWFORD, TIARA SHACOLE
Entity type:Individual
Prefix:MS
First Name:TIARA
Middle Name:SHACOLE
Last Name:CRAWFORD
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 1:36 E CAMERON ST # 19
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74103-1405
Mailing Address - Country:US
Mailing Address - Phone:918-829-3942
Mailing Address - Fax:
Practice Address - Street 1:1890 N HARTFORD AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74106-3550
Practice Address - Country:US
Practice Address - Phone:918-829-3942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-12
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider