Healthcare Provider Details

I. General information

NPI: 1366695884
Provider Name (Legal Business Name): CHERYL ANN TATKA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHERYL BRINLEY

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1957 OHIO DR
GROVE CITY OH
43123-4835
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-366-5671
  • Fax: 614-688-7581
Mailing address:
  • Phone: 614-366-5671
  • Fax: 614-688-7581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.10411
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: