Healthcare Provider Details

I. General information

NPI: 1154043099
Provider Name (Legal Business Name): TANA GINN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2022
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2177 MOCK RD
COLUMBUS OH
43219-1258
US

IV. Provider business mailing address

1 MARION AVE STE 105
MANSFIELD OH
44903-7906
US

V. Phone/Fax

Practice location:
  • Phone: 419-982-2970
  • Fax:
Mailing address:
  • Phone: 419-989-7028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: