MEDICARE: TASHIA FOWLKES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide	400360060504	OH

General Provider Information

NPI Number	:	1407795610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TASHIA FOWLKES

Provider Business Mailing Address
First Line	:	2645 E 122ND ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44120-1442
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2645 E 122ND ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44120-1442
Country	:	US
Telephone Number	:	216-609-9527
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2026
Last Update Date	:	03/25/2026

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