Provider Demographics
NPI:1235842949
Name:TROUTMAN, TAR'RA NICHOLE
Entity Type:Individual
Prefix:
First Name:TAR'RA
Middle Name:NICHOLE
Last Name:TROUTMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5799 WENGLER DR
Mailing Address - Street 2:
Mailing Address - City:BROOKPARK
Mailing Address - State:OH
Mailing Address - Zip Code:44142-2128
Mailing Address - Country:US
Mailing Address - Phone:216-357-8386
Mailing Address - Fax:
Practice Address - Street 1:5799 WENGLER DR
Practice Address - Street 2:
Practice Address - City:BROOKPARK
Practice Address - State:OH
Practice Address - Zip Code:44142-2128
Practice Address - Country:US
Practice Address - Phone:216-357-8386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty