Healthcare Provider Details

I. General information

NPI: 1609145671
Provider Name (Legal Business Name): TARA LYNNE PARKER R.N,B.S.N, APN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TARA LYNNE PARKER NP-C

II. Dates (important events)

Enumeration Date: 12/21/2011
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3458 NEELY RD
MCGUIRE AFB NJ
08641-5312
US

IV. Provider business mailing address

3458 NEELY RD
MC GUIRE AFB NJ
08641-5312
US

V. Phone/Fax

Practice location:
  • Phone: 866-377-2778
  • Fax:
Mailing address:
  • Phone: 866-377-2778
  • Fax: 609-754-9249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11013191
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00359200
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF310241
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code163WF0300X
TaxonomyFlight Registered Nurse
License Number26NO11482300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: