Healthcare Provider Details

I. General information

NPI: 1649114166
Provider Name (Legal Business Name): TARA CLIFF RN, LSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 PEAVEY RD
CHASKA MN
55318-2321
US

IV. Provider business mailing address

3044 FAIRWAY DR
CHASKA MN
55318-3410
US

V. Phone/Fax

Practice location:
  • Phone: 952-556-6100
  • Fax:
Mailing address:
  • Phone: 952-270-3912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR131702-2
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: