Provider Demographics
NPI:1679314728
Name:HEINRICH, TARA (NP)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:HEINRICH
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 1:436 AMHERST ST STE 101
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03063-1276
Mailing Address - Country:US
Mailing Address - Phone:603-577-3003
Mailing Address - Fax:603-577-3331
Practice Address - Street 1:436 AMHERST ST STE 101
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063-1276
Practice Address - Country:US
Practice Address - Phone:603-577-3003
Practice Address - Fax:603-577-3331
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH063791-23363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner