MEDICARE: NICHOLAS TJALAS

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1962949107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS TJALAS

Provider Business Mailing Address
First Line	:	7620 N HARTMAN LN STE 178
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85743-7485
Country	:	US
Telephone Number	:	520-585-5858
Fax Number	:	520-635-4879

Provider Business Practice Location Address
First Line	:	7620 N HARTMAN LN STE 178
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85743-7485
Country	:	US
Telephone Number	:	520-585-5858
Fax Number	:	520-635-4879

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

Provider Enumeration Date	:	01/26/2017
Last Update Date	:	02/04/2021

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Directions to “ NICHOLAS TJALAS ” Practice Location

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