Provider Demographics
NPI:1346037850
Name:WILLIAMS, TARA (BSN RN)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:
Credentials:BSN RN
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:WHITESIDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7733 N DAVIS RD
Mailing Address - Street 2:
Mailing Address - City:BRUCEVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47516-6075
Mailing Address - Country:US
Mailing Address - Phone:812-549-1551
Mailing Address - Fax:
Practice Address - Street 1:7733 N DAVIS RD
Practice Address - Street 2:
Practice Address - City:BRUCEVILLE
Practice Address - State:IN
Practice Address - Zip Code:47516-6075
Practice Address - Country:US
Practice Address - Phone:812-549-1551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28209677A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse