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Individual
TARA NAOMI NICOLETTE
Active
Individual
TARA NAOMI NICOLETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
0116023970
VA
207RI0200X
Infectious Disease Physician
02005888A
IN
207RI0200X
Infectious Disease Physician
Primary
22008
NH
207RI0200X
Infectious Disease Physician
36193
SC
207RI0200X
Infectious Disease Physician
95410
GA
207RI0200X
Infectious Disease Physician
DO2022-0140
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
15322065000171
—
VA
05
—
361932
—
SC
01
—
SCM1003365
MEDICARE PIN
SC
Enumeration date
04/30/2012
Last updated
01/20/2026
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