Look up the most recent NPI and PECOS records

Tara Carroll

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

9900 Bren Rd E, Minnetonka, MN 55343-9664

PECOS Enrollment

Based on the most recent information from CMS, provider Tara Carroll is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 4 days ago.

Profile Details

Provider ID
1700448073
Provider Type
Individual
Full Name
Carroll, Tara
Gender
Female

Sole Proprietor
No
Enumeration Date
7/8/2019
Last Updated
9/14/2020

Contact Information

Practice Location

9900 Bren Rd E, Minnetonka, MN 55343-9664

(423) 480-4060

Unlisted Fax

Mailing Location

235 Dry Hollow Rd, Elizabethton, TN 37643-5619

Unlisted Phone

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363L00000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 5011965 North Carolina

Tara Carroll

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Nonnenmocher, Michelle April

Soderstrom, Dawn E

Depas, Shelby A

Ruiz-Sanchez, Odalys

Brands, Kimberly Kay

Russell, Maryanne

Wells, Angela G

Hardman, Angela Faye

Zakroczynski, Kathleen Johanna

Alexander, Gweneth L