Provider Demographics
NPI:1265077572
Name:FLANAGAN, TARA LYNETTE (WHNP-BC)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:LYNETTE
Last Name:FLANAGAN
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4409 N COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-1933
Mailing Address - Country:US
Mailing Address - Phone:317-258-3027
Mailing Address - Fax:
Practice Address - Street 1:2629 WATERFRONT PARKWAY EAST DR STE 375
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46214-2026
Practice Address - Country:US
Practice Address - Phone:317-885-4200
Practice Address - Fax:317-602-1611
Is Sole Proprietor?:No
Enumeration Date:2019-11-11
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN104544879363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health