Provider Demographics
NPI:1245038728
Name:TACKETT, NICOLE R (RN)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:R
Last Name:TACKETT
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 MOUND ST
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-3050
Mailing Address - Country:US
Mailing Address - Phone:567-674-0887
Mailing Address - Fax:
Practice Address - Street 1:835 N LOCUST ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:OH
Practice Address - Zip Code:45875-1216
Practice Address - Country:US
Practice Address - Phone:419-523-4300
Practice Address - Fax:419-523-6188
Is Sole Proprietor?:No
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.378346163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse