MEDICARE: TARA CUNNINGHAM FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	R195886	MD
2	363L00000X	Nurse Practitioner	R195886	MD

General Provider Information

NPI Number	:	1538059001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA CUNNINGHAM FNP-BC

Provider Business Mailing Address
First Line	:	3508 WORTHINGTON BLVD UNIT 101
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21704-7077
Country	:	US
Telephone Number	:	240-961-8177
Fax Number	:

Provider Business Practice Location Address
First Line	:	3508 WORTHINGTON BLVD UNIT 101
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21704-7077
Country	:	US
Telephone Number	:	410-967-3995
Fax Number	:	410-967-3995

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2025
Last Update Date	:	03/08/2026

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