Individual
JENNIFER M TANDOC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6125 N MAIN ST, DAYTON, OH 45415-3110
(731) 394-1145
Mailing address
36 PEMBERTON CV, JACKSON, TN 38305-5514
(731) 394-1145
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
3003193
KY
363LF0000X
Family Nurse Practitioner
Primary
APRN.CNP.06859
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3088224
—
OH
01
—
500012750
RAILROAD MEDICARE
KY
05
—
78003720
—
KY
01
—
P00847802
RAILROAD MEDICARE
KY
Enumeration date
07/06/2006
Last updated
04/24/2020
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