Provider Demographics
NPI:1053922294
Name:ANDERSON, TACARA NICHOLE (APRN, FNP-C)
Entity type:Individual
Prefix:MS
First Name:TACARA
Middle Name:NICHOLE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 IRVING ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20422-0001
Mailing Address - Country:US
Mailing Address - Phone:202-745-8000
Mailing Address - Fax:949-569-5074
Practice Address - Street 1:50 IRVING ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20422-2050
Practice Address - Country:US
Practice Address - Phone:202-745-8000
Practice Address - Fax:949-569-5074
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR101776163W00000X
AR125423363LF0000X
VA0024180193363LF0000X
MDAC003520363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse