Healthcare Provider Details

I. General information

NPI: 1417888728
Provider Name (Legal Business Name): TIERRA TYLER CCMA, CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: POETIC TYLER CCMA, CNA

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 ISLAND DR # 252
ALAMEDA CA
94502-6781
US

IV. Provider business mailing address

875 ISLAND DR # 252
ALAMEDA CA
94502-6781
US

V. Phone/Fax

Practice location:
  • Phone: 470-590-9483
  • Fax:
Mailing address:
  • Phone: 470-590-9483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number01308658
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: