Provider Demographics
NPI:1427344837
Name:TATAR, TRACEY M (RN)
Entity type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:M
Last Name:TATAR
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 1:5421 COLUMBIANA NEW CASTLE RD
Mailing Address - Street 2:
Mailing Address - City:NEW MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44442-9720
Mailing Address - Country:US
Mailing Address - Phone:330-502-2855
Mailing Address - Fax:
Practice Address - Street 1:5421 COLUMBIANA NEW CASTLE RD
Practice Address - Street 2:
Practice Address - City:NEW MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:44442-9720
Practice Address - Country:US
Practice Address - Phone:330-542-2855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN525695163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0053916Medicaid
OH500514OtherDODD