Provider Demographics
NPI:1134637200
Name:OLIVO-MOORE, TARA (FNP)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:OLIVO-MOORE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:OLIVO-MOORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:254B MOUNTAIN AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-2413
Mailing Address - Country:US
Mailing Address - Phone:908-852-6400
Mailing Address - Fax:908-852-6450
Practice Address - Street 1:254B MOUNTAIN AVE STE 304
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-2413
Practice Address - Country:US
Practice Address - Phone:908-852-6400
Practice Address - Fax:908-852-6450
Is Sole Proprietor?:No
Enumeration Date:2018-01-11
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00775500363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily