Healthcare Provider Details

I. General information

NPI: 1104704105
Provider Name (Legal Business Name): TIERRA A JMAES MEDICAL ASSISTANT II
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5239 JOSEPH ST
MAPLE HEIGHTS OH
44137-1533
US

IV. Provider business mailing address

5239 JOSEPH ST
MAPLE HEIGHTS OH
44137-1533
US

V. Phone/Fax

Practice location:
  • Phone: 216-609-6034
  • Fax:
Mailing address:
  • Phone: 216-609-6034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: