Healthcare Provider Details

I. General information

NPI: 1235957499
Provider Name (Legal Business Name): MRS. TARA NASH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2024
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1747 BEAM AVE STE 100
MAPLEWOOD MN
55109-1128
US

IV. Provider business mailing address

1747 BEAM AVE STE 100
MAPLEWOOD MN
55109-1128
US

V. Phone/Fax

Practice location:
  • Phone: 651-326-5569
  • Fax:
Mailing address:
  • Phone: 651-326-5569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8739
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: