Healthcare Provider Details

I. General information

NPI: 1164854295
Provider Name (Legal Business Name): TARSICIO GACHERU CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2013
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 BRYDEN RD STE 122
COLUMBUS OH
43215-4839
US

IV. Provider business mailing address

6852 ALBANY GLN
NEW ALBANY OH
43054-9385
US

V. Phone/Fax

Practice location:
  • Phone: 614-681-0012
  • Fax: 614-412-6944
Mailing address:
  • Phone: 614-787-5182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.14891-NP
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCOA.14891-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: