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NPI Code Detail

MEDICARE: TAVISSA GRANGER PMHNP-BC

MEDICARE: TAVISSA GRANGER PMHNP-BC
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
1363LP0808XPsychiatric/Mental Health Nurse PractitionerAPRN.CNP.0036206OH

General Provider Information

NPI Number : 1326870254
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAVISSA GRANGER PMHNP-BC
Provider Business Mailing Address
First Line : 4850 SMITH RD STE 250
Second Line :
City : CINCINNATI
State : OH
Zip : 45212-2733
Country : US
Telephone Number :
Fax Number : 513-752-0013
Provider Business Practice Location Address
First Line : 4850 SMITH RD STE 250
Second Line :
City : CINCINNATI
State : OH
Zip : 45212-2733
Country : US
Telephone Number : 513-699-2053
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2024
Last Update Date : 01/14/2026

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Directions to “ TAVISSA GRANGER PMHNP-BC” Practice Location

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