Provider Demographics
NPI:1588949960
Name:COCHRAN, TYESIA (PCA FIDUCIARY NOTARY)
Entity type:Individual
Prefix:
First Name:TYESIA
Middle Name:
Last Name:COCHRAN
Suffix:
Gender:F
Credentials:PCA FIDUCIARY NOTARY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 FLAMINGO WAY
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-6611
Mailing Address - Country:US
Mailing Address - Phone:972-207-0228
Mailing Address - Fax:
Practice Address - Street 1:4301 FLAMINGO WAY
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6611
Practice Address - Country:US
Practice Address - Phone:972-207-0228
Practice Address - Fax:401-425-0308
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2023-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX374U00000X, 372600000X
TX22165985172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide
No172A00000XOther Service ProvidersDriver