Healthcare Provider Details

I. General information

NPI: 1205539327
Provider Name (Legal Business Name): TAQUILLA PHILLIPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 03/27/2023
Certification Date: 03/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 WALNUT TER
AKRON OH
44303-2342
US

IV. Provider business mailing address

164 WALNUT TER
AKRON OH
44303-2342
US

V. Phone/Fax

Practice location:
  • Phone: 330-632-0024
  • Fax:
Mailing address:
  • Phone: 330-632-0024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: