Nicolette, Tara
Nicolette, Tara is an individual health care provider with primary practice located at 101 E Wood St , Spartanburg SC 29303-3040. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Infectious Disease. Allopathic & Osteopathic Physicians / Infectious Disease is her primary health care specialty. Nicolette, Tara can be contacted via phone (864) 560-6806.Contact Information
Primary practice address
101 E Wood St
Spartanburg SC 29303-3040
Phone: (864) 560-6806
Fax: (864) 560-7329
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 0116023970 | Virginia |
| Allopathic & Osteopathic Physicians / Infectious Disease | 207RI0200X | 02005888A | Indiana |
| Allopathic & Osteopathic Physicians / Infectious Disease | 207RI0200X | 36193 | South Carolina |
| Allopathic & Osteopathic Physicians / Infectious Disease | 207RI0200X | DO2022-0140 | New Mexico |
Profile Details
| NPI number | 1942568795 |
|---|---|
| LBN Legal business name | Nicolette, Tara |
| Credentials | Doctor of Osteopathy (DO) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 30th, 2012 |
| Last updated | Jul 19th, 2024 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1942568795 | NPPES |
| South Carolina | MEDICAID | 361932 | |
| South Carolina | Other | SCM1003365 | |
| South Carolina | MEDICAID | 15322065000171 |
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