Individual
MRS. TARA LYNN NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
2600 6TH ST SW, CANTON, OH 44710-1702
(330) 363-1342
Mailing address
2600 6TH ST SW STE A2-800, CANTON, OH 44710-1702
(330) 363-1342
(330) 363-1361
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
365623
OH
363L00000X
Nurse Practitioner
Primary
APRN.CNP.020528
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1205364007
—
OH
Enumeration date
05/24/2017
Last updated
11/23/2022
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