Provider Demographics
NPI:1588421465
Name:WISE, TARA ELIZABETH (APRN, CPNP-PC)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:ELIZABETH
Last Name:WISE
Suffix:
Gender:F
Credentials:APRN, CPNP-PC
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:ELIZABETH
Other - Last Name:MCGUIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1538 FM 36 N
Mailing Address - Street 2:
Mailing Address - City:FARMERSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75442-8028
Mailing Address - Country:US
Mailing Address - Phone:972-816-8630
Mailing Address - Fax:
Practice Address - Street 1:1538 FM 36 N
Practice Address - Street 2:
Practice Address - City:FARMERSVILLE
Practice Address - State:TX
Practice Address - Zip Code:75442-8028
Practice Address - Country:US
Practice Address - Phone:972-816-8630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1060963208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics