Provider Demographics
NPI:1538979505
Name:MATHIS, TANIKA N (RN)
Entity type:Individual
Prefix:
First Name:TANIKA
Middle Name:N
Last Name:MATHIS
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 1:4135 BIRCHALL RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43612-1601
Mailing Address - Country:US
Mailing Address - Phone:513-571-9587
Mailing Address - Fax:
Practice Address - Street 1:4135 BIRCHALL RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43612-1601
Practice Address - Country:US
Practice Address - Phone:513-571-9587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-10
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.501001163W00000X
MI47043928798163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse