Provider Demographics
NPI:1275972192
Name:THOMAS, TARA L (FNP-C)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:L
Last Name:THOMAS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:L
Other - Last Name:SCHNITKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:180 KENNEDY MEMORIAL DR STE 301
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4541
Mailing Address - Country:US
Mailing Address - Phone:207-873-3753
Mailing Address - Fax:207-873-2620
Practice Address - Street 1:180 KENNEDY MEMORIAL DR STE 301
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4541
Practice Address - Country:US
Practice Address - Phone:207-873-3753
Practice Address - Fax:207-873-2620
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP131046363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MECNP131046OtherLICENSE