Healthcare Provider Details

I. General information

NPI: 1902370372
Provider Name (Legal Business Name): TARA BIANCA HOHLSTEIN AGAC DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2019
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3181 CONSERVANCY ESTATES LN
SUN PRAIRIE WI
53590-9249
US

IV. Provider business mailing address

704 ELLIE RAE DR
LODI WI
53555-1468
US

V. Phone/Fax

Practice location:
  • Phone: 608-235-0976
  • Fax:
Mailing address:
  • Phone: 608-370-4757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number232919-30
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number16690-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: