Healthcare Provider Details

I. General information

NPI: 1972909307
Provider Name (Legal Business Name): AMY TAFUR-PARDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2014
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 TOWNSHIP ROAD 2104
LOUDONVILLE OH
44842-9633
US

IV. Provider business mailing address

645 TOWNSHIP ROAD 2104
LOUDONVILLE OH
44842-9800
US

V. Phone/Fax

Practice location:
  • Phone: 419-651-9189
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0041094
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: