Provider Demographics
NPI:1881224202
Name:TAGGS, NICOLE SARA
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:SARA
Last Name:TAGGS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 N SAN ANTONIO RD
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93110-1399
Mailing Address - Country:US
Mailing Address - Phone:805-884-1600
Mailing Address - Fax:
Practice Address - Street 1:2034 DE LA VINA ST # B
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-3814
Practice Address - Country:US
Practice Address - Phone:805-443-0904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-24
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker