Healthcare Provider Details

I. General information

NPI: 1770304248
Provider Name (Legal Business Name): OTISZ NANIKA TUCKER-THOMAS PN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3517 TRIMBLE AVE
CINCINNATI OH
45207-1225
US

IV. Provider business mailing address

3517 TRIMBLE AVE
CINCINNATI OH
45207-1225
US

V. Phone/Fax

Practice location:
  • Phone: 513-473-8789
  • Fax:
Mailing address:
  • Phone: 513-473-8789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: