Provider Demographics
NPI:1518757384
Name:RIGGALL, TARA INEZ (BSN, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:INEZ
Last Name:RIGGALL
Suffix:
Gender:F
Credentials:BSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7888 LARKIN RD
Mailing Address - Street 2:
Mailing Address - City:HUBBARDSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13355-1148
Mailing Address - Country:US
Mailing Address - Phone:607-244-1664
Mailing Address - Fax:
Practice Address - Street 1:128 PHOENIX MILLS RD
Practice Address - Street 2:
Practice Address - City:COOPERSTOWN
Practice Address - State:NY
Practice Address - Zip Code:13326-5716
Practice Address - Country:US
Practice Address - Phone:607-547-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-07
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY775417163WG0600X
NY356912363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0600XNursing Service ProvidersRegistered NurseGerontology