Provider Demographics
NPI:1902186372
Name:TATE, TARA TIERRA (RN)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:TIERRA
Last Name:TATE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 COUNTRY LANE
Mailing Address - Street 2:304
Mailing Address - City:WARRENSVILLE HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44128-6104
Mailing Address - Country:US
Mailing Address - Phone:216-978-4350
Mailing Address - Fax:
Practice Address - Street 1:4800 COUNTRY LANE
Practice Address - Street 2:304
Practice Address - City:WARRENSVILLE HTS
Practice Address - State:OH
Practice Address - Zip Code:44128-6104
Practice Address - Country:US
Practice Address - Phone:216-978-4350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH340779163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical