Healthcare Provider Details

I. General information

NPI: 1174271431
Provider Name (Legal Business Name): TIARA CARDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2022
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11201 SHAKER BLVD
CLEVELAND OH
44104-3869
US

IV. Provider business mailing address

11201 SHAKER BLVD
CLEVELAND OH
44104-3869
US

V. Phone/Fax

Practice location:
  • Phone: 216-758-4120
  • Fax:
Mailing address:
  • Phone: 216-758-4120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN.193062
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: