Provider Demographics
NPI:1447580840
Name:AUTH, TARA HAGGERTY (MS, PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:HAGGERTY
Last Name:AUTH
Suffix:
Gender:F
Credentials:MS, PA-C
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Mailing Address - Street 1:1400 VFW PKWY
Mailing Address - Street 2:DEPARTMENT OF MEDICINE BOX 111
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02132-4927
Mailing Address - Country:US
Mailing Address - Phone:857-203-6341
Mailing Address - Fax:
Practice Address - Street 1:1400 VFW PKWY
Practice Address - Street 2:DEPARTMENT OF MEDICINE BOX 111
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02132-4927
Practice Address - Country:US
Practice Address - Phone:857-203-6341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-06
Last Update Date:2013-05-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MAPA3900364SN0800X
CT002890363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No364SN0800XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistNeuroscience