Provider Demographics
NPI:1871354910
Name:WHITAKER, TIERRA SIRREL
Entity type:Individual
Prefix:
First Name:TIERRA
Middle Name:SIRREL
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 STUART CIR
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27828-8516
Mailing Address - Country:US
Mailing Address - Phone:984-332-1451
Mailing Address - Fax:
Practice Address - Street 1:3737 STUART CIR
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:NC
Practice Address - Zip Code:27828-8516
Practice Address - Country:US
Practice Address - Phone:984-332-1451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home