Healthcare Provider Details

I. General information

NPI: 1144184011
Provider Name (Legal Business Name): NICOLE TADLOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7525 WARREN SHARON RD
BROOKFIELD OH
44403-9796
US

IV. Provider business mailing address

7525 WARREN SHARON RD
BROOKFIELD OH
44403-9796
US

V. Phone/Fax

Practice location:
  • Phone: 330-369-5030
  • Fax: 330-969-1155
Mailing address:
  • Phone: 330-369-5030
  • Fax: 330-969-1155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: