Healthcare Provider Details

I. General information

NPI: 1649487877
Provider Name (Legal Business Name): TARA E TOBIN APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 12/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 N WINCHESTER AVE 2ND FLOOR
CHICAGO IL
60640
US

IV. Provider business mailing address

4501 N WINCHESTER AVE 3RD FLOOR
CHICAGO IL
60640
US

V. Phone/Fax

Practice location:
  • Phone: 773-250-0400
  • Fax: 773-250-0308
Mailing address:
  • Phone: 773-250-0500
  • Fax: 773-250-0497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number041312252
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number209005511
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: