Provider Demographics
NPI:1912988809
Name:TARR, DIANE (NP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:TARR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 ROSEWOOD DR
Mailing Address - Street 2:STE. 104
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-1389
Mailing Address - Country:US
Mailing Address - Phone:978-774-7243
Mailing Address - Fax:978-774-7421
Practice Address - Street 1:1505 COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-3605
Practice Address - Country:US
Practice Address - Phone:617-783-1441
Practice Address - Fax:617-783-1448
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA123730363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP4355OtherBCBS OF MA
MANP4355Medicare PIN
MAQ04189Medicare UPIN