Healthcare Provider Details

I. General information

NPI: 1922695790
Provider Name (Legal Business Name): TARA KAUFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2020
Last Update Date: 12/28/2020
Certification Date: 12/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8645 CONNECTICUT ST
MERRILLVILLE IN
46410-6222
US

IV. Provider business mailing address

1962 SUFFOLK RD
COLUMBUS OH
43221-4247
US

V. Phone/Fax

Practice location:
  • Phone: 219-769-3500
  • Fax:
Mailing address:
  • Phone: 317-750-4432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28263822A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPRN.CNP.0028059
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.458474
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: