Provider Demographics
NPI:1093761512
Name:TARATUTA, BEATA ANNA (MD)
Entity Type:Individual
Prefix:
First Name:BEATA
Middle Name:ANNA
Last Name:TARATUTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 WOODMONT BLVD.
Mailing Address - Street 2:STE 600
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-7528
Mailing Address - Country:US
Mailing Address - Phone:629-224-1618
Mailing Address - Fax:
Practice Address - Street 1:4900 W CRAIG RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130
Practice Address - Country:US
Practice Address - Phone:725-293-5350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9441207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100502642Medicaid
NV38537Medicare ID - Type Unspecified
NVH25994Medicare UPIN