Provider Demographics
NPI:1376619601
Name:FURLONG, TARA MICHELLE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:MICHELLE
Last Name:FURLONG
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:TARA
Other - Middle Name:MICHELLE
Other - Last Name:FURLONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:311 ALBEMARLE RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02460-1358
Mailing Address - Country:US
Mailing Address - Phone:617-304-5445
Mailing Address - Fax:617-795-0552
Practice Address - Street 1:311 ALBEMARLE RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02460-1358
Practice Address - Country:US
Practice Address - Phone:617-304-5445
Practice Address - Fax:617-795-0552
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA217170367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered