Provider Demographics
NPI:1275593667
Name:BHAIDASNA, TARULATA M (ANP-C)
Entity Type:Individual
Prefix:
First Name:TARULATA
Middle Name:M
Last Name:BHAIDASNA
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2737 WARM SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904
Mailing Address - Country:US
Mailing Address - Phone:706-653-2255
Mailing Address - Fax:706-653-2329
Practice Address - Street 1:2600 FERRY ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-3055
Practice Address - Country:US
Practice Address - Phone:765-448-8000
Practice Address - Fax:765-448-8058
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001966A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000623458OtherANTHEM PROVIDER NUMBER
IN200536390Medicaid
INP00824659Medicare PIN
IN815150OOMedicare PIN
IN000000623458OtherANTHEM PROVIDER NUMBER
IN200536390Medicaid