Provider Demographics
NPI:1023008158
Name:BUSSETT, TARA ANN (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:ANN
Last Name:BUSSETT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 W CHESTER PIKE STE 350
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-2738
Mailing Address - Country:US
Mailing Address - Phone:610-853-1112
Mailing Address - Fax:610-446-1425
Practice Address - Street 1:2010 W CHESTER PIKE STE 350
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-2738
Practice Address - Country:US
Practice Address - Phone:610-853-1112
Practice Address - Fax:610-446-1425
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP006453G363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology