Provider Demographics
NPI:1376199067
Name:PONERIS, TARA LYNN (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:LYNN
Last Name:PONERIS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MRS
Other - First Name:TARA
Other - Middle Name:LYNN
Other - Last Name:PONERIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:424 WARDS CORNER RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-6966
Mailing Address - Country:US
Mailing Address - Phone:513-576-7700
Mailing Address - Fax:513-576-1020
Practice Address - Street 1:957A CHERRY ST
Practice Address - Street 2:
Practice Address - City:BLANCHESTER
Practice Address - State:OH
Practice Address - Zip Code:45107-7907
Practice Address - Country:US
Practice Address - Phone:937-783-7111
Practice Address - Fax:937-783-7115
Is Sole Proprietor?:No
Enumeration Date:2019-08-18
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.025384363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0382000Medicaid