Provider Demographics
NPI:1356537328
Name:TLOCZYNSKI, KATHRYN (NP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:TLOCZYNSKI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 SHAWAN FALLS DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-2100
Mailing Address - Country:US
Mailing Address - Phone:614-764-1711
Mailing Address - Fax:614-889-2652
Practice Address - Street 1:650 SHAWAN FALLS DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-2100
Practice Address - Country:US
Practice Address - Phone:614-764-1711
Practice Address - Fax:614-889-2652
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP09572363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1351OtherRR MEDICARE GRP PTAN
OH00737304OtherRR MEDICARE INDIVIDUAL PTAN
OH9932361Medicare PIN
OH00737304OtherRR MEDICARE INDIVIDUAL PTAN