MEDICARE: LACEY LEANN TAKHTAY APRN-CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN.CNP.0032631	OH
2	363LF0000X	Family Nurse Practitioner	232202	AZ
3	363L00000X	Nurse Practitioner	APRN.CNP.0032631	OH

General Provider Information

NPI Number	:	1083258966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LACEY LEANN TAKHTAY APRN-CNP

Provider Business Mailing Address
First Line	:	701 TECH CENTER DR STE 250
Second Line	:
City	:	GAHANNA
State	:	OH
Zip	:	43230-3941
Country	:	US
Telephone Number	:	614-396-2684
Fax Number	:	614-396-2480

Provider Business Practice Location Address
First Line	:	701 TECH CENTER DR
Second Line	:
City	:	GAHANNA
State	:	OH
Zip	:	43230-3940
Country	:	US
Telephone Number	:	614-396-2684
Fax Number	:	614-396-2480

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2019
Last Update Date	:	05/04/2026

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