Provider Demographics
NPI:1407108764
Name:WALTMIRE, TARRA J (APRN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:TARRA
Middle Name:J
Last Name:WALTMIRE
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 MCKINLEY ST
Mailing Address - Street 2:
Mailing Address - City:VAN WERT
Mailing Address - State:OH
Mailing Address - Zip Code:45891-1044
Mailing Address - Country:US
Mailing Address - Phone:419-203-9939
Mailing Address - Fax:
Practice Address - Street 1:933 MCKINLEY ST
Practice Address - Street 2:
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891-1044
Practice Address - Country:US
Practice Address - Phone:419-203-9939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0034316363LF0000X
OH310088163WC3500X, 171M00000X
172A00000X, 347C00000X, 372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC3500XNursing Service ProvidersRegistered NurseCardiac Rehabilitation
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172A00000XOther Service ProvidersDriver
No347C00000XTransportation ServicesPrivate Vehicle
No372500000XNursing Service Related ProvidersChore Provider