Healthcare Provider Details

I. General information

NPI: 1659014223
Provider Name (Legal Business Name): TARA CARTER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2022
Last Update Date: 04/20/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 JEFFERSON ST NE
ALBUQUERQUE NM
87109-4318
US

IV. Provider business mailing address

4917 SANDSTONE DR
FORT COLLINS CO
80526-4561
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-6200
  • Fax:
Mailing address:
  • Phone: 970-219-0389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number67589
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: