Provider Demographics
NPI:1093989733
Name:SMITH, TARA N (FNP-BC)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:N
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1038
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31902-1038
Mailing Address - Country:US
Mailing Address - Phone:706-321-3760
Mailing Address - Fax:706-321-3763
Practice Address - Street 1:705 17TH ST
Practice Address - Street 2:SUITE 106
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-3500
Practice Address - Country:US
Practice Address - Phone:706-321-3760
Practice Address - Fax:706-321-3763
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN128471363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
2006004249-22OtherANCC