Healthcare Provider Details

I. General information

NPI: 1508326794
Provider Name (Legal Business Name): TARA LOCKE MILLER APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS CHRISTINE TARA LOCKE

II. Dates (important events)

Enumeration Date: 03/22/2019
Last Update Date: 03/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE # CA51
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

9500 EUCLID AVE # CA51
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 216-372-1886
  • Fax:
Mailing address:
  • Phone: 216-372-1886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLE-00027634
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: