Provider Demographics
NPI:1497406987
Name:COPPOLA, TARA LYN (ND, MS)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:LYN
Last Name:COPPOLA
Suffix:
Gender:F
Credentials:ND, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:155 BORTHWICK AVE
Mailing Address - Street 2:WEST #102
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-7156
Mailing Address - Country:US
Mailing Address - Phone:603-610-7778
Mailing Address - Fax:603-610-7787
Practice Address - Street 1:155 BORTHWICK AVE # 102
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-7156
Practice Address - Country:US
Practice Address - Phone:603-610-7778
Practice Address - Fax:603-610-7787
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-16
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT59.002157133N00000X
NH0068175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No133N00000XDietary & Nutritional Service ProvidersNutritionist