Healthcare Provider Details

I. General information

NPI: 1871063321
Provider Name (Legal Business Name): TARA MARIE O'ROURKE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2018
Last Update Date: 11/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 4TH ST # M4374
SAN FRANCISCO CA
94143-2350
US

IV. Provider business mailing address

1825 4TH ST FL 4
SAN FRANCISCO CA
94143-2350
US

V. Phone/Fax

Practice location:
  • Phone: 415-885-3606
  • Fax:
Mailing address:
  • Phone: 415-885-3606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95010015
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: