Healthcare Provider Details

I. General information

NPI: 1245637156
Provider Name (Legal Business Name): GEORGE ACHAMBENG TAZI FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2014
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6480 ROCKSIDE WOODS BLVD S STE 330
INDEPENDENCE OH
44131-2222
US

IV. Provider business mailing address

240 PARSONS AVE
COLUMBUS OH
43215-5331
US

V. Phone/Fax

Practice location:
  • Phone: 855-490-9434
  • Fax: 614-645-6091
Mailing address:
  • Phone: 614-645-6792
  • Fax: 614-645-6091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SC1501X
TaxonomyCommunity Health/Public Health Clinical Nurse Specialist
License NumberCOA16825NP
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.16825
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: