Healthcare Provider Details

I. General information

NPI: 1295606242
Provider Name (Legal Business Name): TANEESA RAYNEE BOREMAN MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E WASHINGTON ST
MEDINA OH
44256-2170
US

IV. Provider business mailing address

7005 S EDGERTON RD STE 100
BRECKSVILLE OH
44141-4210
US

V. Phone/Fax

Practice location:
  • Phone: 330-725-1000
  • Fax:
Mailing address:
  • Phone: 440-630-9430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0037503
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: