Provider Demographics
NPI:1912277088
Name:MCKNIGHT-TUFFUOR, TANYA (CNP)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:MCKNIGHT-TUFFUOR
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:
Other - Last Name:MCKNIGHT-TUFFUOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNP
Mailing Address - Street 1:4200 WARRENSVILLE CENTER RD STE 250
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-7000
Mailing Address - Country:US
Mailing Address - Phone:216-491-1178
Mailing Address - Fax:216-491-8486
Practice Address - Street 1:4200 WARRENSVILLE CENTER RD STE 250
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-7000
Practice Address - Country:US
Practice Address - Phone:216-491-1148
Practice Address - Fax:216-491-8486
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-12835363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0059338Medicaid