Provider Demographics
NPI:1578955829
Name:SALAZAR, TARA MEDINA (LPN)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:MEDINA
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 GEORGETOWN AVE APT G28
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-3863
Mailing Address - Country:US
Mailing Address - Phone:330-502-9122
Mailing Address - Fax:
Practice Address - Street 1:347 MIDWAY BLVD STE 110
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-2496
Practice Address - Country:US
Practice Address - Phone:330-324-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.140944.M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse