Healthcare Provider Details

I. General information

NPI: 1215866413
Provider Name (Legal Business Name): TRICIA BARBARA KOXARAKIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

814 DALTON RD
DALTON NH
03598-5731
US

IV. Provider business mailing address

814 DALTON RD
DALTON NH
03598-5731
US

V. Phone/Fax

Practice location:
  • Phone: 603-631-4374
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number075633-21
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: