Provider Demographics
NPI:1952294720
Name:TATE, TYLAYA AMARI
Entity type:Individual
Prefix:
First Name:TYLAYA
Middle Name:AMARI
Last Name:TATE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TYLAYA
Other - Middle Name:AMARI
Other - Last Name:TATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5115 BENNETT RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43612-3443
Mailing Address - Country:US
Mailing Address - Phone:419-309-1776
Mailing Address - Fax:
Practice Address - Street 1:5115 BENNETT RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43612-3443
Practice Address - Country:US
Practice Address - Phone:419-309-1776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-31
Last Update Date:2025-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker