Provider Demographics
NPI:1720471006
Name:BRENNAN SCHUBERT, TARA ANN
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:ANN
Last Name:BRENNAN SCHUBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TARA
Other - Middle Name:ANN
Other - Last Name:BRENNAN SCHUBERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:40 HUNTER PL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-2636
Mailing Address - Country:US
Mailing Address - Phone:917-502-8265
Mailing Address - Fax:
Practice Address - Street 1:40 HUNTER PL
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-2636
Practice Address - Country:US
Practice Address - Phone:917-502-8265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY400544163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse