Healthcare Provider Details

I. General information

NPI: 1821313354
Provider Name (Legal Business Name): FLORAH DEANN TACKETT CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: FLORAH DEANN ORSBORN FNP-C

II. Dates (important events)

Enumeration Date: 03/26/2010
Last Update Date: 05/05/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 E STATE ST
ATHENS OH
45701-2138
US

IV. Provider business mailing address

90 JACKSON PIKE
GALLIPOLIS OH
45631-1562
US

V. Phone/Fax

Practice location:
  • Phone: 740-589-3100
  • Fax: 740-446-5854
Mailing address:
  • Phone: 740-446-5000
  • Fax: 740-446-5854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0038956
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: