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NPI Code Detail

MEDICARE: TARA ANNE CLEARY GNP

MEDICARE: TARA ANNE CLEARY GNP
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
1363LG0600XGerontology Nurse PractitionerF340505NY
2363LG0600XGerontology Nurse Practitioner5009027NC

General Provider Information

NPI Number : 1548342009
Entity Type Code : Individual
Provider Name (Legal Business Name) : TARA ANNE CLEARY GNP
Provider Business Mailing Address
First Line : 7004 BARTONS GROVE PL
Second Line :
City : RALEIGH
State : NC
Zip : 27614-7259
Country : US
Telephone Number : 917-747-7545
Fax Number :
Provider Business Practice Location Address
First Line : 101 CABARRUS AVE E
Second Line :
City : CONCORD
State : NC
Zip : 28025-3699
Country : US
Telephone Number : 984-243-2962
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2006
Last Update Date : 01/22/2026

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