MEDICARE: TARA JO HYSON 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.0035029	OH

General Provider Information

NPI Number	:	1518734789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA JO HYSON CNP

Provider Business Mailing Address
First Line	:	4803 MONTGOMERY RD STE 120
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45212-1153
Country	:	US
Telephone Number	:	513-631-2474
Fax Number	:	513-531-0862

Provider Business Practice Location Address
First Line	:	4803 MONTGOMERY RD STE 120
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45212-1153
Country	:	US
Telephone Number	:	513-631-2474
Fax Number	:	513-531-0862

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

Provider Enumeration Date	:	12/07/2023
Last Update Date	:	08/19/2024

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