Provider Demographics
NPI:1588074751
Name:LAUSCH, TARA HUTCHINSON (NP-C)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:HUTCHINSON
Last Name:LAUSCH
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-3717
Mailing Address - Country:US
Mailing Address - Phone:478-278-4392
Mailing Address - Fax:
Practice Address - Street 1:102 BOWLING LN
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-2502
Practice Address - Country:US
Practice Address - Phone:478-272-0203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-28
Last Update Date:2021-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN213219163W00000X
GA213219363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse