Healthcare Provider Details

I. General information

NPI: 1760660070
Provider Name (Legal Business Name): TARA A WEATHERS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TARA A WEATHERS

II. Dates (important events)

Enumeration Date: 02/08/2008
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 WELLS ST
WESTERLY RI
02891-2922
US

IV. Provider business mailing address

PO BOX 785377
PHILADELPHIA PA
19178-5377
US

V. Phone/Fax

Practice location:
  • Phone: 401-596-8990
  • Fax:
Mailing address:
  • Phone: 203-688-6743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN00110
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNPP37450
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8686
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: