Provider Demographics
NPI:1023989449
Name:GOINES, TYRA
Entity type:Individual
Prefix:
First Name:TYRA
Middle Name:
Last Name:GOINES
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 1:1235 SHAFFER DR APT 2
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-3564
Mailing Address - Country:US
Mailing Address - Phone:440-714-8095
Mailing Address - Fax:
Practice Address - Street 1:1235 SHAFFER DR APT 2
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-3564
Practice Address - Country:US
Practice Address - Phone:440-714-8095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker