Provider Demographics
NPI:1124386347
Name:BARTLETT, TARA CHRISTINE (FNP)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:CHRISTINE
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3213 DALEMEAD ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6920
Mailing Address - Country:US
Mailing Address - Phone:310-408-9154
Mailing Address - Fax:
Practice Address - Street 1:3213 DALEMEAD ST
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6920
Practice Address - Country:US
Practice Address - Phone:310-408-9154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA664986163W00000X
CA95010621363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse