Healthcare Provider Details

I. General information

NPI: 1417519018
Provider Name (Legal Business Name): TARA DAWN BOLAND NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TARA DAWN GARTLING

II. Dates (important events)

Enumeration Date: 07/03/2019
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 W 7TH ST STE 2520
TULSA OK
74119-1104
US

IV. Provider business mailing address

605 S 75TH ST
BROKEN ARROW OK
74014-7080
US

V. Phone/Fax

Practice location:
  • Phone: 185-793-8269
  • Fax:
Mailing address:
  • Phone: 918-688-2970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number207405
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number207405
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: