Provider Demographics
NPI:1477270536
Name:DELGUIDICE, TARA JACQUELINE
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:JACQUELINE
Last Name:DELGUIDICE
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 1:148 RIVERSIDE DR W
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WV
Mailing Address - Zip Code:25130-1118
Mailing Address - Country:US
Mailing Address - Phone:304-787-7426
Mailing Address - Fax:
Practice Address - Street 1:148 RIVERSIDE DR W
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WV
Practice Address - Zip Code:25130-1118
Practice Address - Country:US
Practice Address - Phone:304-787-7426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-20
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant