Provider Demographics
NPI:1215530217
Name:GREENWOOD, TARA LYNN (CNP)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:LYNN
Last Name:GREENWOOD
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-5044
Mailing Address - Country:US
Mailing Address - Phone:575-434-2960
Mailing Address - Fax:575-434-8724
Practice Address - Street 1:1501 10TH ST
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-5044
Practice Address - Country:US
Practice Address - Phone:575-434-2960
Practice Address - Fax:575-434-8724
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM61454363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily