Provider Demographics
NPI:1891966743
Name:GIBLIN, TARA BRIDGET (NP)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:BRIDGET
Last Name:GIBLIN
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:40 SUNSHINE COTTAGE RD.
Mailing Address - Street 2:SKYLINE BUILDING, IN - J08
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595
Mailing Address - Country:US
Mailing Address - Phone:914-594-2179
Mailing Address - Fax:914-594-2143
Practice Address - Street 1:19 BRADHURST AVENUE
Practice Address - Street 2:SUITE 800S
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532
Practice Address - Country:US
Practice Address - Phone:914-493-7997
Practice Address - Fax:914-594-2143
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-19
Last Update Date:2017-03-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY3181949363L00000X
NY381949363LP0200X
NY576025-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02969079Medicaid