Healthcare Provider Details

I. General information

NPI: 1306646211
Provider Name (Legal Business Name): TARA HULL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2025
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2830 S BEVERLY ST
SALT LAKE CITY UT
84106-3170
US

IV. Provider business mailing address

2830 S BEVERLY ST
SALT LAKE CITY UT
84106-3170
US

V. Phone/Fax

Practice location:
  • Phone: 912-506-8486
  • Fax:
Mailing address:
  • Phone: 912-506-8486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10681833-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: