Healthcare Provider Details

I. General information

NPI: 1972640746
Provider Name (Legal Business Name): TARA PIMPINELLO RN, APN,C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 01/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 2ND AVE S SUITE 400
MINNEAPOLIS MN
55402-3318
US

IV. Provider business mailing address

1625 CHARTER OAK AVE
BLACKWOOD NJ
08012-5007
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone: 609-617-3155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number26NR09335300
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NN09335300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: