Healthcare Provider Details

I. General information

NPI: 1851217798
Provider Name (Legal Business Name): RICHARD JAVIER TAVAREZ DNP, FNP-BC, APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 CENTRACARE CIR
SAINT CLOUD MN
56303-5000
US

IV. Provider business mailing address

13065 180TH CT NW
ELK RIVER MN
55330-5642
US

V. Phone/Fax

Practice location:
  • Phone: 320-229-5099
  • Fax:
Mailing address:
  • Phone: 952-393-4399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number14362
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: