Provider Demographics
NPI:1568097418
Name:MIDGETTE, TARRA O (FNP)
Entity Type:Individual
Prefix:
First Name:TARRA
Middle Name:O
Last Name:MIDGETTE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 WOODHILL CT
Mailing Address - Street 2:
Mailing Address - City:KITTY HAWK
Mailing Address - State:NC
Mailing Address - Zip Code:27949-9228
Mailing Address - Country:US
Mailing Address - Phone:252-202-4806
Mailing Address - Fax:
Practice Address - Street 1:101 WOODHILL CT
Practice Address - Street 2:
Practice Address - City:KITTY HAWK
Practice Address - State:NC
Practice Address - Zip Code:27949-9228
Practice Address - Country:US
Practice Address - Phone:252-202-4806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCF02200292363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily