Healthcare Provider Details

I. General information

NPI: 1821489220
Provider Name (Legal Business Name): KRISTIN AMANDA TATARKA RN, FNP-BC, ACNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTIN AMANDA PONZANI RN

II. Dates (important events)

Enumeration Date: 02/07/2015
Last Update Date: 02/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8440 MARKET ST
YOUNGSTOWN OH
44512-6703
US

IV. Provider business mailing address

2218 E MARKET ST
WARREN OH
44483-6106
US

V. Phone/Fax

Practice location:
  • Phone: 330-965-9999
  • Fax: 330-757-0000
Mailing address:
  • Phone: 330-392-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberCOA. 16690-NS
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA. 17884-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: