Provider Demographics
NPI:1497465942
Name:TAGGART, JEAN EVELYN (FNP)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:EVELYN
Last Name:TAGGART
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2418 BRICK HOUSE LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-4545
Mailing Address - Country:US
Mailing Address - Phone:513-543-6456
Mailing Address - Fax:
Practice Address - Street 1:969 READING RD STE N
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-2654
Practice Address - Country:US
Practice Address - Phone:513-604-1004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-23
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF11220286363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily