# TARA NAOMI NICOLETTE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1942568795
- **Gender:** F
- **Credential:** DO

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 0116023970 | VA | — |
| 207RI0200X | Infectious Disease Physician | 02005888A | IN | — |
| 207RI0200X | Infectious Disease Physician | 22008 | NH | Yes |
| 207RI0200X | Infectious Disease Physician | 36193 | SC | — |
| 207RI0200X | Infectious Disease Physician | 95410 | GA | — |
| 207RI0200X | Infectious Disease Physician | DO2022-0140 | NM | — |

## Other

- **Enumeration date:** 04/30/2012
- **Last updated:** 01/20/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 15322065000171 | — | VA |
| 05 | — | 361932 | — | SC |
| 01 | — | SCM1003365 | MEDICARE PIN | SC |