MEDICARE: TARA CLIFF RN, LSN

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	163W00000X	Registered Nurse	R131702-2	MN

General Provider Information

NPI Number	:	1649114166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA CLIFF RN, LSN

Provider Business Mailing Address
First Line	:	3044 FAIRWAY DR
Second Line	:
City	:	CHASKA
State	:	MN
Zip	:	55318-3410
Country	:	US
Telephone Number	:	952-270-3912
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 PEAVEY RD
Second Line	:
City	:	CHASKA
State	:	MN
Zip	:	55318-2321
Country	:	US
Telephone Number	:	952-556-6100
Fax Number	:

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

Provider Enumeration Date	:	04/15/2026
Last Update Date	:	04/15/2026

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