Provider Demographics
NPI:1922300961
Name:PROTACIO, JUDITH A (CNP)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:PROTACIO
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:A
Other - Last Name:MELNIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:1900 23RD ST
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-1404
Mailing Address - Country:US
Mailing Address - Phone:330-971-7221
Mailing Address - Fax:330-971-7582
Practice Address - Street 1:1900 23RD ST
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-1404
Practice Address - Country:US
Practice Address - Phone:330-971-7221
Practice Address - Fax:330-971-7582
Is Sole Proprietor?:No
Enumeration Date:2010-11-24
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP11790363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner