Healthcare Provider Details

I. General information

NPI: 1649761321
Provider Name (Legal Business Name): NAILA TARIQ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 RIVER ST
WELLESLEY MA
02481-2098
US

IV. Provider business mailing address

11 RIVER ST
WELLESLEY MA
02481-2098
US

V. Phone/Fax

Practice location:
  • Phone: 781-431-1177
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209029797
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2303527
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0040096
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: