Provider Demographics
NPI:1902598899
Name:LIMA, TARA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:LIMA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 COMMON ST APT 2
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4774
Mailing Address - Country:US
Mailing Address - Phone:508-713-2503
Mailing Address - Fax:
Practice Address - Street 1:350 MYLES STANDISH BLVD STE 203
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-7387
Practice Address - Country:US
Practice Address - Phone:508-824-1355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2339843163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management