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General NPI Number Information
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NPI Number | 1235827213
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Entity Type | Individual
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Provider Name | TARA OLSEN AGNP
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Gender | Female
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Dates
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Enumeration Date | 04/27/2023
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Last Update Date | 06/08/2023
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Provider Practice Location Address
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Address Line | 400 STATE ST STE 2
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City | PERTH AMBOY
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State | NJ
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Zip | 08861-3486
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Country | US
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Telephone | 732-442-6020
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Fax |
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Provider Business Mailing Address
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Address Line | 585 RIDGEWAY AVE
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City | SOUTH AMBOY
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State | NJ
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Zip | 08879-1045
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 26NJ01475400
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License Number State | NJ
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