Healthcare Provider Details

I. General information

NPI: 1982958799
Provider Name (Legal Business Name): TARA RAE NAGEL CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2012
Last Update Date: 01/12/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4214 MAMIES CIR MIDLAND PEDIATRIC ASSOCIATES
MIDLAND TX
79707
US

IV. Provider business mailing address

4214 MAMIES CIR
MIDLAND TX
79707
US

V. Phone/Fax

Practice location:
  • Phone: 432-620-8687
  • Fax: 432-682-1831
Mailing address:
  • Phone: 432-620-8687
  • Fax: 432-682-1831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number756895
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: