Provider Demographics
NPI:1083202923
Name:OSTROM, TARYN NICOLE (NP-C)
Entity Type:Individual
Prefix:
First Name:TARYN
Middle Name:NICOLE
Last Name:OSTROM
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8180 26 MILE RD # 100
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-5129
Mailing Address - Country:US
Mailing Address - Phone:586-336-7321
Mailing Address - Fax:
Practice Address - Street 1:8180 26 MILE RD # 100
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48316-5129
Practice Address - Country:US
Practice Address - Phone:586-336-7321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704303851363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily