Individual
TARA J QUINTANA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5275 W COWDEN RD # 1052, ELLETTSVILLE, IN 47429-9325
(930) 333-1435
Mailing address
2815 E 3RD ST # 1052, BLOOMINGTON, IN 47401-5434
(930) 333-1435
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
28202480A
IN
Other
Enumeration date
07/16/2021
Last updated
05/16/2023
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