| NPI | 1154930436 |
|---|---|
| Former Name | TIANNA ELAINE MARIE NICHOLAS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209021600) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209.021600) |
| Enumeration Date | 2020-07-23 |
| Last Update Date | 2025-06-30 |