Provider Demographics
NPI:1053976373
Name:BROWN, TARA (RN)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 KEYNOTE CIR STE 300
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44131-1869
Mailing Address - Country:US
Mailing Address - Phone:216-931-1400
Mailing Address - Fax:
Practice Address - Street 1:925 KEYNOTE CIR STE 300
Practice Address - Street 2:
Practice Address - City:BROOKLYN HTS
Practice Address - State:OH
Practice Address - Zip Code:44131-1869
Practice Address - Country:US
Practice Address - Phone:216-931-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.430415163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1306109558OtherCOMPANY NPI
OH2098359Medicaid