Provider Demographics
NPI:1073188611
Name:CARR, TIARA TANEE (CNM)
Entity type:Individual
Prefix:
First Name:TIARA
Middle Name:TANEE
Last Name:CARR
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5299
Mailing Address - Street 2:MS: 820-5-PCO
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98415-0299
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:253-274-7991
Practice Address - Street 1:1450 5TH ST SE STE 3200
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-4689
Practice Address - Country:US
Practice Address - Phone:253-697-3550
Practice Address - Fax:253-697-3490
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60968923163WS0200X
WAAP61338414367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2215256Medicaid