MEDICARE: TARA DAWN BOLAND NP

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	367A00000X	Advanced Practice Midwife	207405	OK
2	363L00000X	Nurse Practitioner	207405	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	R211050	OTHER	MD	STATE LICENSE

General Provider Information

NPI Number	:	1417519018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA DAWN BOLAND NP

Provider Business Mailing Address
First Line	:	605 S 75TH ST
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74014-7080
Country	:	US
Telephone Number	:	918-688-2970
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 W 7TH ST STE 2520
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74119-1104
Country	:	US
Telephone Number	:	185-793-8269
Fax Number	:

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

Provider Enumeration Date	:	07/03/2019
Last Update Date	:	12/08/2025

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Directions to “ TARA DAWN BOLAND NP” Practice Location

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