Provider Demographics
NPI:1679681456
Name:HIEGER, TARA K (NP)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:K
Last Name:HIEGER
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 1:161 MARGINAL WAY
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2438
Mailing Address - Country:US
Mailing Address - Phone:207-773-7964
Mailing Address - Fax:207-773-9073
Practice Address - Street 1:161 MARGINAL WAY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2438
Practice Address - Country:US
Practice Address - Phone:207-773-7964
Practice Address - Fax:207-773-9073
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP81240363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1679681456Medicaid
MEE400122660Medicare PIN