Provider Demographics
NPI:1851346712
Name:GUCKERT, TAMARA ANN (RN, BSN)
Entity Type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:ANN
Last Name:GUCKERT
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:695 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-2847
Mailing Address - Country:US
Mailing Address - Phone:614-296-8074
Mailing Address - Fax:
Practice Address - Street 1:695 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-2847
Practice Address - Country:US
Practice Address - Phone:614-296-8074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-138112163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2539551Medicaid