Provider Demographics
NPI:1891446449
Name:KILMARTIN, TARASITA (NP)
Entity type:Individual
Prefix:
First Name:TARASITA
Middle Name:
Last Name:KILMARTIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 US HIGHWAY 395 N
Mailing Address - Street 2:
Mailing Address - City:GARDNERVILLE
Mailing Address - State:NV
Mailing Address - Zip Code:89410-5204
Mailing Address - Country:US
Mailing Address - Phone:775-783-1127
Mailing Address - Fax:775-201-1172
Practice Address - Street 1:1520 US HIGHWAY 395 N
Practice Address - Street 2:
Practice Address - City:GARDNERVILLE
Practice Address - State:NV
Practice Address - Zip Code:89410-5204
Practice Address - Country:US
Practice Address - Phone:775-783-1127
Practice Address - Fax:775-201-1172
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-14
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVF12210345363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily