Healthcare Provider Details

I. General information

NPI: 1134637200
Provider Name (Legal Business Name): TARA OLIVO-MOORE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TARA OLIVO-MOORE FNP

II. Dates (important events)

Enumeration Date: 01/11/2018
Last Update Date: 01/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254B MOUNTAIN AVE STE 304
HACKETTSTOWN NJ
07840-2413
US

IV. Provider business mailing address

254B MOUNTAIN AVE STE 304
HACKETTSTOWN NJ
07840-2413
US

V. Phone/Fax

Practice location:
  • Phone: 908-852-6400
  • Fax: 908-852-6450
Mailing address:
  • Phone: 908-852-6400
  • Fax: 908-852-6450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00775500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: