Provider Demographics
NPI:1538927389
Name:EVANS, TIA JAVONNE
Entity type:Individual
Prefix:
First Name:TIA
Middle Name:JAVONNE
Last Name:EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TIA
Other - Middle Name:JAVONNE
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1059 ADDICE WAY
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45224-2701
Mailing Address - Country:US
Mailing Address - Phone:513-328-3177
Mailing Address - Fax:
Practice Address - Street 1:1059 ADDICE WAY
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45224-2701
Practice Address - Country:US
Practice Address - Phone:513-328-3177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management