Provider Demographics
NPI:1578542056
Name:BEIGHTOL, TARA R (NP)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:R
Last Name:BEIGHTOL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4230 HARDING PIKE STE 527
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2098
Mailing Address - Country:US
Mailing Address - Phone:615-386-3067
Mailing Address - Fax:615-385-0612
Practice Address - Street 1:4230 HARDING PIKE STE 527
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2098
Practice Address - Country:US
Practice Address - Phone:615-386-3067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7800363LF0000X
VA0001216242363LF0000X
VA0017138930363LF0000X
DCRN1035917363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3640836Medicaid
TN3640836Medicare ID - Type Unspecified
TN3640836Medicaid