Provider Demographics
NPI:1437878881
Name:TAGGART, NINA
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:TAGGART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 DURANT AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-1660
Mailing Address - Country:US
Mailing Address - Phone:415-231-9711
Mailing Address - Fax:
Practice Address - Street 1:415 GEORGIA ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-6004
Practice Address - Country:US
Practice Address - Phone:707-556-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker