Healthcare Provider Details

I. General information

NPI: 1538843248
Provider Name (Legal Business Name): TINA MILLISON APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2023
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4235 TUSCARAWAS ST W
CANTON OH
44708-5424
US

IV. Provider business mailing address

4235 TUSCARAWAS ST W SPC C
CANTON OH
44708-5424
US

V. Phone/Fax

Practice location:
  • Phone: 234-203-4232
  • Fax: 330-266-4386
Mailing address:
  • Phone: 234-254-7484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0034004
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: