Healthcare Provider Details

I. General information

NPI: 1952248007
Provider Name (Legal Business Name): TIA HICKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

588 BLANCHE ST
AKRON OH
44307-1609
US

IV. Provider business mailing address

588 BLANCHE ST
AKRON OH
44307-1609
US

V. Phone/Fax

Practice location:
  • Phone: 330-400-9652
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number401988190717
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: