Healthcare Provider Details

I. General information

NPI: 1053922294
Provider Name (Legal Business Name): TACARA NICHOLE ANDERSON APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2020
Last Update Date: 01/03/2026
Certification Date: 01/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11618 CLAYTON BLVD
CLAYTON NC
27520-2275
US

IV. Provider business mailing address

11618 CLAYTON BLVD
CLAYTON NC
27520-2275
US

V. Phone/Fax

Practice location:
  • Phone: 919-416-8010
  • Fax:
Mailing address:
  • Phone: 919-416-8010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5016648
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024180193
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAC003520
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: