Provider Demographics
NPI:1215732326
Name:CHOATES, TIARA CASSANDRA
Entity type:Individual
Prefix:
First Name:TIARA
Middle Name:CASSANDRA
Last Name:CHOATES
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 1:46 FOSTER AVE
Mailing Address - Street 2:
Mailing Address - City:SHARON HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19079-1907
Mailing Address - Country:US
Mailing Address - Phone:610-457-0092
Mailing Address - Fax:
Practice Address - Street 1:46 FOSTER AVE
Practice Address - Street 2:
Practice Address - City:SHARON HILL
Practice Address - State:PA
Practice Address - Zip Code:19079-1907
Practice Address - Country:US
Practice Address - Phone:610-457-0092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN323047164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse