Provider Demographics
NPI:1407335607
Name:GUTIERREZ, TARA DENISE (DNP, APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:DENISE
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8405 MAHOGANY CT
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-2089
Mailing Address - Country:US
Mailing Address - Phone:956-791-1414
Mailing Address - Fax:
Practice Address - Street 1:6602 POLARIS DR STE 5
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-2082
Practice Address - Country:US
Practice Address - Phone:956-791-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1166650363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily