Provider Demographics
NPI:1992312045
Name:HARRIS, TAMIA RONIQUE (RN)
Entity type:Individual
Prefix:
First Name:TAMIA
Middle Name:RONIQUE
Last Name:HARRIS
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 1:3627 HARVEY RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-2215
Mailing Address - Country:US
Mailing Address - Phone:951-966-7542
Mailing Address - Fax:
Practice Address - Street 1:20728 DONNY BROOK RD
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-3112
Practice Address - Country:US
Practice Address - Phone:216-581-1585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.302571163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse