Healthcare Provider Details

I. General information

NPI: 1649762451
Provider Name (Legal Business Name): TARRA MARSH BOYD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TARRA MARSH BOYD FNP

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E ROOSEVELT BLVD STE 800A
MONROE NC
28112-5187
US

IV. Provider business mailing address

PO BOX 278
WAXHAW NC
28173-1043
US

V. Phone/Fax

Practice location:
  • Phone: 704-776-4048
  • Fax: 877-497-4784
Mailing address:
  • Phone: 704-776-4048
  • Fax: 877-497-4784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5010579
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: