Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | RN2278596 | MA |
N | 363LW0102X | Nurse Practitioner - Women's Health | RN2278596 | MA |
NPI | 1013341163 |
---|---|
Provider Name | Ms. Tamar E Siracusa |
First Address | North Quincy, MA 02171-2122 |
Second Address | North Quincy, MA 02171-2122 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2013 |
Last Update Date | 11/12/2014 |