Provider Demographics
NPI:1336803659
Name:WEIR, TARA L (DNP, ARNP, FNP-C)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:L
Last Name:WEIR
Suffix:
Gender:F
Credentials:DNP, ARNP, FNP-C
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:L
Other - Last Name:WYNKOOP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 11401
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52410-1401
Mailing Address - Country:US
Mailing Address - Phone:319-551-2620
Mailing Address - Fax:
Practice Address - Street 1:1350 BOYSON RD STE C1
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233-2211
Practice Address - Country:US
Practice Address - Phone:319-551-2620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-22
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA165921363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA5206922OtherCSA
IAMW6810039OtherDEA