Provider Demographics
NPI:1497092928
Name:WILLIAMS, TARA (ANP-BC, RN)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:ANP-BC, RN
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:LAMESA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP-BC, RN
Mailing Address - Street 1:47 SOUTH RD
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-4539
Mailing Address - Country:US
Mailing Address - Phone:860-989-2138
Mailing Address - Fax:
Practice Address - Street 1:70 BUCKLAND RD
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-3702
Practice Address - Country:US
Practice Address - Phone:860-648-0707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-03
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT87625163W00000X
MARN2269388163W00000X
CT005200363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse