Provider Demographics
NPI:1881109809
Name:NORVEZ, TARA ANNE (RN)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:ANNE
Last Name:NORVEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7934 68TH RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-2915
Mailing Address - Country:US
Mailing Address - Phone:347-401-2348
Mailing Address - Fax:
Practice Address - Street 1:2501 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-5095
Practice Address - Country:US
Practice Address - Phone:718-533-6754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-13
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY555177163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY555177OtherNYS NURSING