Healthcare Provider Details

I. General information

NPI: 1578082665
Provider Name (Legal Business Name): TARYN TEGARDEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2017
Last Update Date: 09/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2651 BURNET AVE
CINCINNATI OH
45219-2551
US

IV. Provider business mailing address

2651 BURNET AVE
CINCINNATI OH
45219-2551
US

V. Phone/Fax

Practice location:
  • Phone: 513-363-0248
  • Fax:
Mailing address:
  • Phone: 513-363-0248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number421614
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: