Provider Demographics
NPI:1750714390
Name:TARKENTON, VERONICA (APRN)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:TARKENTON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27610 CAROLINE CIR APT B
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-1128
Mailing Address - Country:US
Mailing Address - Phone:619-204-8133
Mailing Address - Fax:
Practice Address - Street 1:3745 GROVE AVE
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44055-2734
Practice Address - Country:US
Practice Address - Phone:440-240-1655
Practice Address - Fax:440-240-1655
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.19015363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0179296Medicaid