Provider Demographics
NPI:1295750867
Name:NIMIROSKI, TARA (RN PRACTIONER)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:NIMIROSKI
Suffix:
Gender:F
Credentials:RN PRACTIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 WORCESTER ST
Mailing Address - Street 2:STE 3
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01151-1045
Mailing Address - Country:US
Mailing Address - Phone:413-543-6820
Mailing Address - Fax:413-543-7962
Practice Address - Street 1:795 MIDDLE ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-1733
Practice Address - Country:US
Practice Address - Phone:508-235-5262
Practice Address - Fax:508-235-5275
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA198513363LA2100X
RI37254363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
412033OtherB CHIP
29071OtherBC
412033OtherB CHIP
509003920Medicare ID - Type Unspecified
Q33707Medicare UPIN