Provider Demographics
NPI:1821313354
Name:TACKETT, FLORAH DEANN (LPN)
Entity Type:Individual
Prefix:
First Name:FLORAH
Middle Name:DEANN
Last Name:TACKETT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:FLORAH
Other - Middle Name:DEANN
Other - Last Name:ORSBORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:622 BROHARD RD
Mailing Address - Street 2:
Mailing Address - City:RAY
Mailing Address - State:OH
Mailing Address - Zip Code:45672-9618
Mailing Address - Country:US
Mailing Address - Phone:740-357-6961
Mailing Address - Fax:
Practice Address - Street 1:622 BROHARD RD
Practice Address - Street 2:
Practice Address - City:RAY
Practice Address - State:OH
Practice Address - Zip Code:45672-9618
Practice Address - Country:US
Practice Address - Phone:740-357-6961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-26
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.135461164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse