Healthcare Provider Details

I. General information

NPI: 1700288263
Provider Name (Legal Business Name): TARA BARKER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2014
Last Update Date: 09/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 SYLVAN ST. SUITE 102B
DANVERS MA
01923
US

IV. Provider business mailing address

75 SYLVAN ST SUITE 102B
DANVERS MA
01923
US

V. Phone/Fax

Practice location:
  • Phone: 978-774-7566
  • Fax: 978-223-9766
Mailing address:
  • Phone: 978-774-7566
  • Fax: 978-223-9766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number237483
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: