Provider Demographics
NPI:1396210506
Name:MARIPOSA FAMILY MEDICINE
Entity Type:Organization
Organization Name:MARIPOSA FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TANI
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHARE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:505-859-4191
Mailing Address - Street 1:5910 CUBERO DR NE STE A
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3868
Mailing Address - Country:US
Mailing Address - Phone:505-859-4191
Mailing Address - Fax:505-308-3192
Practice Address - Street 1:5910 CUBERO DR NE STE A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3868
Practice Address - Country:US
Practice Address - Phone:505-856-3321
Practice Address - Fax:505-212-0152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-04
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty