1215575220 NPI number — TIANA M WRIGHT

Table of content: TIANA M WRIGHT (NPI 1215575220)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215575220 NPI number — TIANA M WRIGHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WRIGHT
Provider First Name:
TIANA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215575220
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/05/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6113 CAMBRIDGE DR W, SUFFOLK, VA 23435, USA
Provider Second Line Business Mailing Address:
6113 CAMBRIDGE DR, W SUFFOLK, VA. 23435
Provider Business Mailing Address City Name:
SUFFOLK
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23435
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-807-4207
Provider Business Mailing Address Fax Number:
757-210-4044

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6113 CAMBRIDGE DR W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUFFOLK
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23435-3143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-210-4044
Provider Business Practice Location Address Fax Number:
757-210-4044
Provider Enumeration Date:
12/20/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HCO-202215 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 343900000X , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1265074850 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com