Provider Demographics
NPI:1295370963
Name:TROFA, TARA BETH (MS, BSN, CRNA, CCRN)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:BETH
Last Name:TROFA
Suffix:
Gender:F
Credentials:MS, BSN, CRNA, CCRN
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:BETH
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:64 MIDLAND PL APT 2511
Mailing Address - Street 2:
Mailing Address - City:TUCKAHOE
Mailing Address - State:NY
Mailing Address - Zip Code:10707-4250
Mailing Address - Country:US
Mailing Address - Phone:704-902-8085
Mailing Address - Fax:
Practice Address - Street 1:630 W 168TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3725
Practice Address - Country:US
Practice Address - Phone:704-902-8085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-16
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC267282163W00000X
NY781579163W00000X
CT169590163W00000X
NC124323367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse