Individual
TARIS GONZALEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
8391 S SHADY TRAIL DR, PENDLETON, IN 46064-8652
(317) 507-2395
Mailing address
8391 S SHADY TRAIL DR, PENDLETON, IN 46064-8652
(317) 743-0009
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71001601A
IN
363LA2100X
Acute Care Nurse Practitioner
71001601
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200460280
—
IN
01
—
P01170026
RR MEDICARE PTAN
IN
Enumeration date
06/04/2007
Last updated
11/27/2023
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