Healthcare Provider Details

I. General information

NPI: 1083258966
Provider Name (Legal Business Name): LACEY LEANN TAKHTAY APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LACEY LEANN LITTERAL

II. Dates (important events)

Enumeration Date: 11/04/2019
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 TECH CENTER DR
GAHANNA OH
43230-3940
US

IV. Provider business mailing address

701 TECH CENTER DR STE 250
GAHANNA OH
43230-3941
US

V. Phone/Fax

Practice location:
  • Phone: 614-396-2684
  • Fax: 614-396-2480
Mailing address:
  • Phone: 614-396-2684
  • Fax: 614-396-2480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0032631
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0032631
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number232202
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: