Provider Demographics
NPI:1982787586
Name:HUGHES, TARA LYNNE (NP)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:LYNNE
Last Name:HUGHES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 MICHIGAN AVE STE 270
Mailing Address - Street 2:
Mailing Address - City:LOGANSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:46947-1530
Mailing Address - Country:US
Mailing Address - Phone:574-722-4921
Mailing Address - Fax:574-739-0520
Practice Address - Street 1:1201 MICHIGAN AVE STE 270
Practice Address - Street 2:
Practice Address - City:LOGANSPORT
Practice Address - State:IN
Practice Address - Zip Code:46947-1530
Practice Address - Country:US
Practice Address - Phone:574-722-4921
Practice Address - Fax:574-739-0520
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001977363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200816280Medicaid
IN151990BBBMedicare PIN
IN151560K2Medicare PIN
INQ66446Medicare UPIN