Basic Information
| Provider Information | |||||||||
| NPI: | 1235344078 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARINO | ||||||||
| FirstName: | TARA | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 HIGH ST. | ||||||||
| Address2: | |||||||||
| City: | MILLVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8566913300 | ||||||||
| FaxNumber: | 8567947183 | ||||||||
| Practice Location | |||||||||
| Address1: | 319 W LANDIS AVE | ||||||||
| Address2: | |||||||||
| City: | VINELAND | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 083608101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8566913300 | ||||||||
| FaxNumber: | 8567947183 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 26NJ0054300 | NJ | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.