Provider Demographics
NPI:1376767061
Name:GOLDIN, TARA SKYE (ND)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:SKYE
Last Name:GOLDIN
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 BROADWAY ST
Mailing Address - Street 2:SUITE 12
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3100
Mailing Address - Country:US
Mailing Address - Phone:303-443-2206
Mailing Address - Fax:303-449-5756
Practice Address - Street 1:3011 BROADWAY ST
Practice Address - Street 2:SUITE 12
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3100
Practice Address - Country:US
Practice Address - Phone:303-443-2206
Practice Address - Fax:303-449-5756
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT6175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath