Healthcare Provider Details

I. General information

NPI: 1679314728
Provider Name (Legal Business Name): TARA HEINRICH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 AMHERST ST STE 101
NASHUA NH
03063-1276
US

IV. Provider business mailing address

436 AMHERST ST STE 101
NASHUA NH
03063-1276
US

V. Phone/Fax

Practice location:
  • Phone: 603-577-3003
  • Fax: 603-577-3331
Mailing address:
  • Phone: 603-577-3003
  • Fax: 603-577-3331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number063791-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: