Provider Demographics
NPI:1972384634
Name:REZEY, TARA ANN (MSN FNP-BC CCRN)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:ANN
Last Name:REZEY
Suffix:
Gender:F
Credentials:MSN FNP-BC CCRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 SARATOGA RD
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-3503
Mailing Address - Country:US
Mailing Address - Phone:518-728-1214
Mailing Address - Fax:
Practice Address - Street 1:1 ATWELL RD
Practice Address - Street 2:CARDIOVASCULAR SERVICES
Practice Address - City:COOPERSTOWN
Practice Address - State:NY
Practice Address - Zip Code:13326-1394
Practice Address - Country:US
Practice Address - Phone:607-547-7920
Practice Address - Fax:607-547-4901
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY350804363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health