Provider Demographics
NPI:1316599863
Name:BURKE-MUSCATELLO, TARA A (FNP-BC)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:A
Last Name:BURKE-MUSCATELLO
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 1:258 USHERS RD STE 203
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-1428
Mailing Address - Country:US
Mailing Address - Phone:518-782-3815
Mailing Address - Fax:518-649-4094
Practice Address - Street 1:258 USHERS RD STE 203
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-1428
Practice Address - Country:US
Practice Address - Phone:518-588-3961
Practice Address - Fax:518-909-8488
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-15
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY402734363LP0808X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner