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General NPI Number Information
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NPI Number | 1326083551
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Entity Type | Individual
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Provider Name | TARA L GONSALVES NP
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Gender | Female
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1 DEL POND DR
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City | CANTON
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State | MA
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Zip | 02021-2759
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Country | US
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Telephone | 781-821-3210
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Fax |
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Provider Business Mailing Address
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Address Line | 39 PARSONS WALK
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City | BERKLEY
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State | MA
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Zip | 02779-1628
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Country | US
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Telephone | 508-822-2979
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 232268
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License Number State | MA
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