Provider Demographics
NPI:1841827185
Name:AUGUSTE, TARAH
Entity type:Individual
Prefix:
First Name:TARAH
Middle Name:
Last Name:AUGUSTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14711 227TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11413-3237
Mailing Address - Country:US
Mailing Address - Phone:917-325-0696
Mailing Address - Fax:
Practice Address - Street 1:14711 227TH ST
Practice Address - Street 2:
Practice Address - City:SPRNGFLD GDNS
Practice Address - State:NY
Practice Address - Zip Code:11413-3237
Practice Address - Country:US
Practice Address - Phone:917-325-0696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-26
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF309450363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health