Provider Demographics
NPI:1851708309
Name:LOAIZA, TARA (APN)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:
Last Name:LOAIZA
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 KINGSLAND ST
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-1215
Mailing Address - Country:US
Mailing Address - Phone:973-661-2732
Mailing Address - Fax:
Practice Address - Street 1:91 MAIN ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07505-1026
Practice Address - Country:US
Practice Address - Phone:973-523-4000
Practice Address - Fax:973-689-3081
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00505400363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology