MEDICARE: MRS. TARA NASH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	8739	MN

General Provider Information

NPI Number	:	1235957499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TARA NASH

Provider Business Mailing Address
First Line	:	1747 BEAM AVE STE 100
Second Line	:
City	:	MAPLEWOOD
State	:	MN
Zip	:	55109-1128
Country	:	US
Telephone Number	:	651-326-5569
Fax Number	:

Provider Business Practice Location Address
First Line	:	1747 BEAM AVE STE 100
Second Line	:
City	:	MAPLEWOOD
State	:	MN
Zip	:	55109-1128
Country	:	US
Telephone Number	:	651-326-5569
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2024
Last Update Date	:	06/23/2026

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