Provider Demographics
NPI:1689039562
Name:MCMILLAN, TARA L (FNP-C)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:L
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25207 W INDIAN BOUNDARY CT
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-7775
Mailing Address - Country:US
Mailing Address - Phone:630-890-7481
Mailing Address - Fax:
Practice Address - Street 1:6545 W ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-2555
Practice Address - Country:US
Practice Address - Phone:630-947-6131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-21
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277000113363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily