Individual
TARA LEIGH MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
172 KINSLEY ST, NASHUA, NH 03060-3648
(603) 595-3175
Mailing address
C/O ST MARY'S HEALTH SYSTEM - PROVIDER ENROLLMENT, PO BOX 7291, LEWISTON, ME 04243-7291
(207) 777-8695
(207) 777-8800
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
197868
MA
363LF0000X
Family Nurse Practitioner
Primary
079641-23
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3117943
—
NH
Enumeration date
02/27/2019
Last updated
06/05/2020
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