DR. JORDAN ZANE TACKTILL (NPI# 1942560727) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942560727 |
| Entity Type | Individual |
| Full Name | DR. JORDAN ZANE TACKTILL |
| Credential | DPM |
| Practice Address |
222 Walnut Ave Sw Roanoke VA 24016-4723 |
| Practice Telephone | 5403443668 |
| Mailing Telephone | 5403443668 |
| Enumeration Date | 2012-05-25 |
| Last Update Date | 2013-10-15 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 213ES0103X |
Podiatrist Specialization: Foot & Ankle Surgery |
0103301083 | VA | Podiatric Medicine & Surgery Service Providers |
| N | 213ES0103X |
Podiatrist Specialization: Foot & Ankle Surgery |
PO3534 | FL | Podiatric Medicine & Surgery Service Providers |
| Street Address |
222 WALNUT AVE SW |
| City | ROANOKE |
| State | VA |
| Zip Code | 24016-4723 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508837402 | Charles M Zelen | Podiatrist | 222 Walnut Ave Sw, Roanoke, VA 24016-4723 | 2006-01-30 |
| 1689020703 | Ivan Rubiano | Podiatrist | 222 Walnut Ave Sw, Roanoke, VA 24016-4723 | 2016-05-07 |
| 1831506146 | Boyd Jensen IIi | Podiatrist | 222 Walnut Ave Sw, Roanoke, VA 24016-4723 | 2014-07-18 |
| 1841425600 | Nathan John Young | Podiatrist | 222 Walnut Ave Sw, Roanoke, VA 24016-4723 | 2009-05-22 |
| 1053503961 | David Lamont Nielson | Podiatrist | 222 Walnut Ave Sw, Roanoke, VA 24016-4723 | 2007-08-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134758329 | Davis Andrew Sugar | Student in an Organized Health Care Education/Training Program | 1 Riverside Circle, Suite 401, Roanoke, Va, 24016, Suite 401, Roanoke, VA 24016 | 2020-04-08 |
| 1356810659 | Susanne Tribble | Social Worker | 202 Wells Ave Nw, Roanoke, VA 24016 | 2018-11-15 |
| 1801305818 | Rena Lee Daye | Driver | 10 12th St. Sw, Roanoke, VA 24016 | 2017-09-21 |
| 1053841965 | Christin Elledge Clark | Nurse Practitioner | 1234 Franklin Road, Roanoke, VA 24016 | 2017-06-13 |
| 1235685884 | Helen Franck | Physical Therapist | 650 North Jefferson Street, Roanoke, VA 24016 | 2016-09-01 |
| 1457710238 | Frances Marie Gaeta | Social Worker | 360 Campbell Ave, Roanoke, VA 24016 | 2016-02-22 |
| 1982073292 | Sophie Mench Tranmer | Physical Therapist | 1421 Third St. Sw, Roanoke, VA 24016 | 2015-09-16 |
| 1982008181 | National Counseling Group, Inc | Psychiatry & Neurology | 20 Walnut Avenue, Roanoke, VA 24016 | 2014-10-17 |
| 1366858342 | National Counseling Group, Inc | Psychiatry & Neurology | 16 Walnut Avenue, Roanoke, VA 24016 | 2014-07-10 |
| 1427320878 | Kristen L. Jagger | Physical Medicine & Rehabilitation | 1015 First Street Sw Suite 2, Roanoke, VA 24016 | 2012-02-01 |
| Find all providers in zip 24016 | ||||
| Taxonomy Code | 213ES0103X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| Specialization | Foot & Ankle Surgery |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497399687 | Roanoke Foot & Ankle Institute, Pllc | Podiatrist | 351 W Byron Nelson Blvd, Suite 100, Roanoke, TX 76262 | 2019-10-31 |
| 1912391293 | Natalie Hoffman | Podiatrist | 60 Summerfield Ct Ste 102, Roanoke, VA 24019-4579 | 2015-03-24 |
| 1790837425 | Samantha Childers | Podiatrist | 351 W. Byron Nelson Blvd, Suite 100, Roanoke, TX 76262 | 2007-01-16 |
| 1508837402 | Charles M Zelen | Podiatrist | 222 Walnut Ave Sw, Roanoke, VA 24016-4723 | 2006-01-30 |
| 1063862035 | Wesley Maurice Leong | Podiatrist | 1906 Belleview Ave Se, Roanoke, VA 24014-1838 | 2016-06-20 |
| 1689020703 | Ivan Rubiano | Podiatrist | 222 Walnut Ave Sw, Roanoke, VA 24016-4723 | 2016-05-07 |
| 1508253683 | Blayne Kenneth Patton | Podiatrist | 3 Riverside Cir, Roanoke, VA 24016 | 2015-04-16 |
| 1841425600 | Nathan John Young | Podiatrist | 222 Walnut Ave Sw, Roanoke, VA 24016-4723 | 2009-05-22 |
| 1053503961 | David Lamont Nielson | Podiatrist | 222 Walnut Ave Sw, Roanoke, VA 24016-4723 | 2007-08-14 |
| 1497813430 | Advanced Foot and Ankle Center, Pllc | Podiatrist | 1121 S Jefferson St, Roanoke, VA 24016-4703 | 2006-12-04 |
| Find all providers in ROANOKE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.