Provider Demographics
NPI:1699341545
Name:KNOTT, TIAURA AQUILA
Entity type:Individual
Prefix:MISS
First Name:TIAURA
Middle Name:AQUILA
Last Name:KNOTT
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 1:4559 BENNING RD SE APT 103
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-5169
Mailing Address - Country:US
Mailing Address - Phone:301-728-0125
Mailing Address - Fax:
Practice Address - Street 1:2104 RIDGECREST CT SE APT 101
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-6218
Practice Address - Country:US
Practice Address - Phone:202-749-9148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374700000XNursing Service Related ProvidersTechnicianGroup - Single Specialty