Healthcare Provider Details

I. General information

NPI: 1356912273
Provider Name (Legal Business Name): TANNER NASH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2021
Last Update Date: 12/15/2022
Certification Date: 12/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29000 CENTER RIDGE RD
WESTLAKE OH
44145-5219
US

IV. Provider business mailing address

29000 CENTER RIDGE RD
WESTLAKE OH
44145-5219
US

V. Phone/Fax

Practice location:
  • Phone: 440-847-9956
  • Fax:
Mailing address:
  • Phone: 440-847-9956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number57.253845
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberRL17506
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: