Provider Demographics
NPI:1609332188
Name:TARALA, MARIA (APRN, CNP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:TARALA
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:VERONICA
Other - Last Name:JIMENEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12251 S 80TH AVE
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1290
Mailing Address - Country:US
Mailing Address - Phone:708-923-5869
Mailing Address - Fax:708-923-5859
Practice Address - Street 1:12251 S 80TH AVE
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1256
Practice Address - Country:US
Practice Address - Phone:630-257-1111
Practice Address - Fax:630-257-1115
Is Sole Proprietor?:No
Enumeration Date:2019-02-20
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.018455363LF0000X
IL209018455363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty