Provider Demographics
NPI:1184032773
Name:JARRETT, TAMARA DAWN (RN, BSN)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:DAWN
Last Name:JARRETT
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2715 SANDY LAKE RD
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-8210
Mailing Address - Country:US
Mailing Address - Phone:330-353-4991
Mailing Address - Fax:
Practice Address - Street 1:2715 SANDY LAKE RD
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-8210
Practice Address - Country:US
Practice Address - Phone:330-353-4991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-26
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
373H00000X, 251C00000X, 251E00000X, 251S00000X, 253Z00000X
OHRN285337163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care