Healthcare Provider Details

I. General information

NPI: 1750285052
Provider Name (Legal Business Name): LAKISHA MONIQUE TUGGLE LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

962 FORESTBROOK LN
PAINESVILLE OH
44077-7604
US

IV. Provider business mailing address

962 FORESTBROOK LN UPPR
PAINESVILLE OH
44077-7604
US

V. Phone/Fax

Practice location:
  • Phone: 216-577-4630
  • Fax: 205-660-6438
Mailing address:
  • Phone: 216-577-4630
  • Fax: 205-660-6438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number183819
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: