Provider Demographics
NPI:1881052744
Name:FERGUSON, TARA C (CNP)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:C
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:C
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2971 GRAHAM RD
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-3619
Mailing Address - Country:US
Mailing Address - Phone:330-688-7981
Mailing Address - Fax:330-688-7469
Practice Address - Street 1:2971 GRAHAM RD
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-3619
Practice Address - Country:US
Practice Address - Phone:330-688-7981
Practice Address - Fax:330-688-7469
Is Sole Proprietor?:No
Enumeration Date:2016-02-08
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA18742NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0158308Medicaid
OH0158308Medicaid