Provider Demographics
NPI:1528446234
Name:HUKILL, TINA MARIE
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:HUKILL
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:TINA
Other - Middle Name:MARIE
Other - Last Name:HUKILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:2859 THACKERAY AVE NW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-2666
Mailing Address - Country:US
Mailing Address - Phone:330-546-6256
Mailing Address - Fax:
Practice Address - Street 1:2859 THACKERAY AVE NW
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-2666
Practice Address - Country:US
Practice Address - Phone:330-546-6236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN082609164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse