TARA N PEACOCK (NPI# 1376976332) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376976332 |
| Entity Type | Individual |
| Full Name | TARA N PEACOCK |
| Credential | CNP |
| Practice Address |
1021 Bandana Blvd E Suite 100 Saint Paul MN 55108-5113 |
| Mailing Address |
2925 Chicago Ave Minneapolis MN 55407-1321 |
| Practice Telephone | 6512419700 |
| Mailing Telephone | 6122625000 |
| Mailing Fax Number | 6122624258 |
| Enumeration Date | 2013-08-14 |
| Last Update Date | 2014-03-03 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
R1753372 | MN | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1021 BANDANA BLVD E SUITE 100 |
| City | SAINT PAUL |
| State | MN |
| Zip Code | 55108-5113 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700867967 | Charles Edward Kath | Dentist | 1021 Bandana Blvd E, Saint Paul, MN 55108-5113 | 2005-11-07 |
| 1871946459 | Rachel Zerby | Audiologist | 1021 Bandana Blvd E, Suite 100, Saint Paul, MN 55108-5113 | 2016-07-19 |
| 1285085274 | Megan Elyse Welborn | Dentist | 1021 Bandana Blvd E, Saint Paul, MN 55108-5113 | 2016-06-30 |
| 1821451774 | Edlund Dental, LLC | Dentist | 1021 Bandana Blvd E, Suite #105, Saint Paul, MN 55108-5113 | 2016-03-29 |
| 1417344110 | Laurel Urquhart Welch | Physical Therapist | 1021 Bandana Blvd E, Suite 123, Saint Paul, MN 55108-5113 | 2015-04-20 |
| 1124437108 | Kimberley Mullin | Physician Assistant | 1021 Bandana Blvd E, Suite 100, Saint Paul, MN 55108-5113 | 2014-08-04 |
| 1770990467 | Gabrielle Rivard | Physician Assistant | 1021 Bandana Blvd E, Saint Paul, MN 55108-5113 | 2014-07-15 |
| 1831521848 | Hnouchi Patricia Lochungvu | Family Medicine | 1021 Bandana Blvd E, Suite #100, Saint Paul, MN 55108-5113 | 2013-07-31 |
| 1447537162 | Michelle Josephine Parra | Physical Therapist | 1021 Bandana Blvd E, Suite 123, Saint Paul, MN 55108-5113 | 2011-11-09 |
| 1326353731 | Sarah A Siemer | Physical Therapist | 1021 Bandana Blvd E, Saint Paul, MN 55108-5113 | 2010-08-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306490677 | Kyle Leonard Bernier | Student in an Organized Health Care Education/Training Program | 1295 Bandana Blvd W, Suite 210, St. Paul, MN 55108 | 2019-07-25 |
| 1356870778 | Kathleen Louise Kocon | Marriage & Family Therapist | 2230 Como Ave., Saint Paul, MN 55108 | 2017-06-08 |
| 1871965830 | Jill Hansen | Specialist | 1449 Clevland Ave N, The Emily Program, Saint Paul, MN 55108 | 2015-10-29 |
| 1871821140 | Angela Joyce Anderson | Speech-Language Pathologist | 2266 Hillside Avenue, Saint Paul, MN 55108 | 2009-11-25 |
| 1265769418 | Dakota Baker | Counselor | 1360 Energy Park Drive Suite 340, St. Paul, MN 55108 | 2009-11-09 |
| 1255583449 | Suzanne Elizabeth Trunnell | Nurse Practitioner | 1020 Bandana Blvd. W, Aspen Medical Group--bandana Square, St. Paul, MN 55108 | 2008-10-21 |
| 1982851358 | Kimberly Joy Bahma | Pharmacist | 1295 Bandana Blvd, Suite 335, Saint Paul, MN 55108 | 2008-08-27 |
| 1952566093 | Caring Professionals Homecare, LLC | Home Health | 1543 Como Ave Ste 101, Saint Paul, MN 55108 | 2008-07-28 |
| 1700077344 | Archana Mani | Dentist | 1021 Bandana Blvd E Ste 121, Saint Paul, MN 55108 | 2007-08-08 |
| 1457554735 | Catherine Lawrence Scharlau | Psychologist | 1295 Bandana Blvd. North, Aspen Medical Group-behavioral Health, St. Paul, MN 55108 | 2007-06-06 |
| Find all providers in zip 55108 | ||||
| Taxonomy Code | 363LA2200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Adult Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649830225 | Kimberly Dawn Hanson | Nurse Practitioner | 1884 Randolph Ave, Saint Paul, MN 55105-1747 | 2019-06-17 |
| 1962879916 | Carrie Rose Lucio | Nurse Practitioner | 807 Albert St N, Saint Paul, MN 55104-1302 | 2015-08-25 |
| 1639302276 | Laurel Gail Ostrow | Nurse Practitioner | 1368 Simpson St, Saint Paul, MN 55108-2427 | 2009-08-31 |
| 1801085436 | Kathryn Ann Mcnaul | Nurse Practitioner | 1600 Grand Ave, Winton Health Services, Saint Paul, MN 55105-1801 | 2007-10-19 |
| 1396747143 | Colleen Rae Caspers | Nurse Practitioner | 2550 University Ave W, Suite 423 South, Saint Paul, MN 55114-1052 | 2005-08-11 |
| 1902805146 | Kristi R Swarthwood | Nurse Practitioner | 225 Smith Ave N, Suite 400, Saint Paul, MN 55102-2533 | 2005-07-19 |
| 1881164804 | Jo Walker | Nurse Practitioner | 1055 Westgate Dr, Saint Paul, MN 55114-1065 | 2018-12-03 |
| 1689159360 | Morgan Llewellyn Mcdonald Weinert | Nurse Practitioner | 153 Cesar Chavez St, Saint Paul, MN 55107-2226 | 2018-09-28 |
| 1831677780 | Deanna Marie Heine | Nurse Practitioner | 1700 University Ave W Fl 1, Saint Paul, MN 55104-3727 | 2018-08-02 |
| 1386141554 | Binta Fatmata Barry | Nurse Practitioner | 255 Smith Ave N Ste 100, Saint Paul, MN 55102 | 2018-04-12 |
| Find all providers in SAINT PAUL | ||||
| City | SAINT PAUL |
| Zip Code | 55108 |
Please comment or provide details below to improve the information on TARA N PEACOCK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.