Individual
TARA SIPE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7910 W JEFFERSON BLVD STE 112, FORT WAYNE, IN 46804-4159
(260) 969-7121
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71005342A
IN
Other
Enumeration date
02/09/2015
Last updated
10/10/2022
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