Healthcare Provider Details

I. General information

NPI: 1972631414
Provider Name (Legal Business Name): DIANE M TARANTINO ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 09/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 CASE DR
REVERE MA
02151-2831
US

IV. Provider business mailing address

71 CASE DR
REVERE MA
02151-2831
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-6620
  • Fax: 617-724-6282
Mailing address:
  • Phone: 617-724-6620
  • Fax: 617-724-6282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number163884
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: