Provider Demographics
NPI:1841077641
Name:POWER, TARYN ALICIA (CPNP-PC)
Entity type:Individual
Prefix:
First Name:TARYN
Middle Name:ALICIA
Last Name:POWER
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:TARYN
Other - Middle Name:ALICIA
Other - Last Name:RICKERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:8740 FOSTER CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MEADE
Mailing Address - State:MD
Mailing Address - Zip Code:20755-1502
Mailing Address - Country:US
Mailing Address - Phone:706-831-6160
Mailing Address - Fax:
Practice Address - Street 1:11161 NEW HAMPSHIRE AVE STE 301
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-2606
Practice Address - Country:US
Practice Address - Phone:301-681-7101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC005839363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics