Provider Demographics
NPI:1700447554
Name:HEMINGWAY, TACARA NICHOLE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:TACARA
Middle Name:NICHOLE
Last Name:HEMINGWAY
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 VERNON RD STE 1500
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-4166
Mailing Address - Country:US
Mailing Address - Phone:706-884-1712
Mailing Address - Fax:706-223-1934
Practice Address - Street 1:1605 VERNON RD STE 1500
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-4166
Practice Address - Country:US
Practice Address - Phone:706-884-1712
Practice Address - Fax:706-223-1934
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN221486363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner