Provider Demographics
NPI:1699170316
Name:MCFADDEN, TARA LYNNE (APRN)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:LYNNE
Last Name:MCFADDEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 POSTCREEK RD
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-2515
Mailing Address - Country:US
Mailing Address - Phone:513-502-6964
Mailing Address - Fax:
Practice Address - Street 1:1360 POSTCREEK RD
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-2515
Practice Address - Country:US
Practice Address - Phone:513-502-6964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.337297-COA1163W00000X
OHCOA.16613-NP363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse