Provider Demographics
NPI:1215234216
Name:HARRISON, TIA L (RN)
Entity type:Individual
Prefix:
First Name:TIA
Middle Name:L
Last Name:HARRISON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:438 BURKHART LN
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1063
Mailing Address - Country:US
Mailing Address - Phone:740-612-2926
Mailing Address - Fax:740-578-6133
Practice Address - Street 1:438 BURKHART LN
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1063
Practice Address - Country:US
Practice Address - Phone:740-612-2926
Practice Address - Fax:740-578-6133
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-28
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN352461163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse