Provider Demographics
NPI:1144521022
Name:MEIZINGER, TARA M (ARNP)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:M
Last Name:MEIZINGER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:M
Other - Last Name:KERNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:881 LE COVE DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-1650
Mailing Address - Country:US
Mailing Address - Phone:620-404-9019
Mailing Address - Fax:
Practice Address - Street 1:1564 LASKIN RD STE 178
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-6187
Practice Address - Country:US
Practice Address - Phone:757-938-3915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-09
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011013790363L00000X
KS53-75230-101363L00000X
VA0024187060363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200680500AMedicaid
MOMA1085006OtherMEDICARE PTAN
KS068002101OtherMEDICARE PTAN