Provider Demographics
NPI:1629690508
Name:NICHOLS, TARA (ARNP)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 1ST ST NW STE 101
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-2932
Mailing Address - Country:US
Mailing Address - Phone:641-428-3041
Mailing Address - Fax:
Practice Address - Street 1:910 N EISENHOWER AVE
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-1525
Practice Address - Country:US
Practice Address - Phone:641-428-5911
Practice Address - Fax:641-428-5927
Is Sole Proprietor?:No
Enumeration Date:2020-05-13
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAW158701363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology