Provider Demographics
NPI:1801428842
Name:MURPHY, TARA (FNP)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:MURPHY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 WILLOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-4327
Mailing Address - Country:US
Mailing Address - Phone:716-432-2779
Mailing Address - Fax:
Practice Address - Street 1:1120 YOUNGS RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-2695
Practice Address - Country:US
Practice Address - Phone:716-923-7326
Practice Address - Fax:716-250-4000
Is Sole Proprietor?:No
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY345467363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily