Provider Demographics
NPI:1053808014
Name:COTTON, TIYANNA LYNNE (LPN)
Entity type:Individual
Prefix:
First Name:TIYANNA
Middle Name:LYNNE
Last Name:COTTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1191 REESE AVE
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-2070
Mailing Address - Country:US
Mailing Address - Phone:419-979-7373
Mailing Address - Fax:
Practice Address - Street 1:1191 REESE AVE
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-2070
Practice Address - Country:US
Practice Address - Phone:419-979-7373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-16
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.167732.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse