Individual
TARA JENNINGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
55 FRUIT ST, ACC 735, BOSTON, MA 02114-2621
(617) 726-3311
(617) 726-9250
Mailing address
3400 SPRUCE ST, 2 RAVDIN, PHILADELPHIA, PA 19104
(215) 662-3606
(215) 349-5579
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
SP022480
PA
363LA2200X
Adult Health Nurse Practitioner
262759
MA
Other
Enumeration date
11/05/2007
Last updated
10/01/2020
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