Provider Demographics
NPI:1366695884
Name:TATKA, CHERYL ANN (APRN)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:ANN
Last Name:TATKA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:
Other - Last Name:BRINLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-366-5671
Mailing Address - Fax:614-688-7581
Practice Address - Street 1:1957 OHIO DR
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-4835
Practice Address - Country:US
Practice Address - Phone:614-366-5671
Practice Address - Fax:614-688-7581
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.10411363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3041569Medicaid