Healthcare Provider Details

I. General information

NPI: 1992233456
Provider Name (Legal Business Name): TANA ANN WHITT APRN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TANA ANN HENLEY

II. Dates (important events)

Enumeration Date: 05/30/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3593 MEDINA RD STE 181
MEDINA OH
44256-8182
US

IV. Provider business mailing address

3593 MEDINA RD STE 181
MEDINA OH
44256-8182
US

V. Phone/Fax

Practice location:
  • Phone: 330-536-3746
  • Fax: 888-204-5174
Mailing address:
  • Phone: 330-536-3746
  • Fax: 888-204-5174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number399935
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberAPRNCNP021116
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.021116
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: