Provider Demographics
NPI:1891977534
Name:BIGBEE, TARA MARSHIA (LPN)
Entity Type:Individual
Prefix:MISS
First Name:TARA
Middle Name:MARSHIA
Last Name:BIGBEE
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 1:4361 CLARKWOOD PKWY
Mailing Address - Street 2:APT 433
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-4821
Mailing Address - Country:US
Mailing Address - Phone:216-702-4232
Mailing Address - Fax:
Practice Address - Street 1:4361 CLARKWOOD PKWY
Practice Address - Street 2:APT 433
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-4821
Practice Address - Country:US
Practice Address - Phone:216-702-4232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN107950164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2683985Medicaid