Healthcare Provider Details

I. General information

NPI: 1841127602
Provider Name (Legal Business Name): TIA SERAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3961A MARKET ST
WILMINGTON NC
28403-1403
US

IV. Provider business mailing address

113 BROOKVIEW RD
WILMINGTON NC
28409-9132
US

V. Phone/Fax

Practice location:
  • Phone: 910-352-4555
  • Fax:
Mailing address:
  • Phone: 541-606-1071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberLAC-2308
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: