Provider Demographics
NPI:1417277500
Name:MEYER, TARA BLUE (APRN)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:BLUE
Last Name:MEYER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:BLUE
Other - Last Name:MULLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:353 BLAIR PK. RD.
Mailing Address - Street 2:UVM MEDICAL CENTER - PCIM/WILLISTON
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495
Mailing Address - Country:US
Mailing Address - Phone:802-847-1470
Mailing Address - Fax:802-847-7135
Practice Address - Street 1:353 BLAIR PK. RD.
Practice Address - Street 2:UVM MEDICAL CENTER - PCIM/WILLISTON
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495
Practice Address - Country:US
Practice Address - Phone:802-847-1470
Practice Address - Fax:802-847-7135
Is Sole Proprietor?:No
Enumeration Date:2010-06-11
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0076732363LF0000X
NH062569-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily