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General NPI Number Information
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NPI Number | 1689487043
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Entity Type | Individual
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Provider Name | TARA AGWU
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Gender | Female
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Dates
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Enumeration Date | 01/29/2025
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Last Update Date | 07/31/2025
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Provider Practice Location Address
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Address Line | 124 SLEEPY HOLLOW DR STE 240
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City | MIDDLETOWN
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State | DE
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Zip | 19709-5838
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Country | US
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Telephone | 302-400-9999
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Fax | 302-600-3578
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Provider Business Mailing Address
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Address Line | PO BOX 67537
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City | NEWARK
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State | NJ
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Zip | 07101-8009
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Country | US
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Telephone | 302-400-9999
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Fax | 302-600-3578
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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 | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number | L1-0054564
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | LG-0013112
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License Number State | DE
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