Provider Demographics
NPI:1124434253
Name:KOLBERG, TARA ROCHELLE (WHNP)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:ROCHELLE
Last Name:KOLBERG
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1718 MENAUL BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-1030
Mailing Address - Country:US
Mailing Address - Phone:505-249-7592
Mailing Address - Fax:
Practice Address - Street 1:6801 JEFFERSON ST NE STE 350
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4361
Practice Address - Country:US
Practice Address - Phone:505-847-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDEM-LD-10163507176B00000X
NM63727363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No176B00000XOther Service ProvidersMidwife