Provider Demographics
NPI:1922809995
Name:MINNICK, TRICIA ANN (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:TRICIA
Middle Name:ANN
Last Name:MINNICK
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:TRICIA
Other - Middle Name:ANN
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:9067 BROADVIEW RD
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-2512
Mailing Address - Country:US
Mailing Address - Phone:330-978-4883
Mailing Address - Fax:
Practice Address - Street 1:9067 BROADVIEW RD
Practice Address - Street 2:
Practice Address - City:BROADVIEW HTS
Practice Address - State:OH
Practice Address - Zip Code:44147-2512
Practice Address - Country:US
Practice Address - Phone:330-978-4883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 3747P1801X
OH3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No251E00000XAgenciesHome Health