Provider Demographics
NPI:1952143208
Name:MCCOLL, TARA LYNN (FNP)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:LYNN
Last Name:MCCOLL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:TARA
Other - Middle Name:LYNN
Other - Last Name:VANNOSTRAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 ATWELL RD
Mailing Address - Street 2:
Mailing Address - City:COOPERSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13326-1394
Mailing Address - Country:US
Mailing Address - Phone:607-547-6366
Mailing Address - Fax:607-547-3844
Practice Address - Street 1:1 ATWELL RD
Practice Address - Street 2:
Practice Address - City:COOPERSTOWN
Practice Address - State:NY
Practice Address - Zip Code:13326-1394
Practice Address - Country:US
Practice Address - Phone:518-234-2555
Practice Address - Fax:518-234-3415
Is Sole Proprietor?:No
Enumeration Date:2024-06-08
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF354244363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner