Provider Demographics
NPI:1265306815
Name:GAINES, TEQUILA CHEVONNE
Entity type:Individual
Prefix:
First Name:TEQUILA
Middle Name:CHEVONNE
Last Name:GAINES
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 1:5617 TELLURIDE BLF
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-6719
Mailing Address - Country:US
Mailing Address - Phone:380-900-2863
Mailing Address - Fax:
Practice Address - Street 1:5617 TELLURIDE BLF
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-6719
Practice Address - Country:US
Practice Address - Phone:380-900-2863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-06
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide