Healthcare Provider Details

I. General information

NPI: 1295750867
Provider Name (Legal Business Name): TARA NIMIROSKI RN PRACTIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 ATWOOD AVE STE 220
JOHNSTON RI
02919-3278
US

IV. Provider business mailing address

1524 ATWOOD AVE STE 220
JOHNSTON RI
02919-3278
US

V. Phone/Fax

Practice location:
  • Phone: 401-272-1900
  • Fax: 401-453-3049
Mailing address:
  • Phone: 401-272-1900
  • Fax: 401-453-3049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number37254
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number198513
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: