Healthcare Provider Details

I. General information

NPI: 1659217636
Provider Name (Legal Business Name): TIERRA MARIE VAUGHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

932 LASSER DR
NORFOLK VA
23513-2919
US

IV. Provider business mailing address

932 LASSER DR
NORFOLK VA
23513-2919
US

V. Phone/Fax

Practice location:
  • Phone: 757-615-4145
  • Fax:
Mailing address:
  • Phone: 757-615-4145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number943769
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: