Provider Demographics
NPI:1508019100
Name:GREER, TARA B (ANP)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:B
Last Name:GREER
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 FAULK ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-5263
Mailing Address - Country:US
Mailing Address - Phone:704-290-0444
Mailing Address - Fax:704-290-0445
Practice Address - Street 1:1650 FAULK ST
Practice Address - Street 2:SUITE A
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5263
Practice Address - Country:US
Practice Address - Phone:704-290-0444
Practice Address - Fax:704-290-0445
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004144363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP1359Medicaid
NC7004437Medicaid
SCNP1359Medicaid