Tara Peterson, APNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

15899-33 Issued in WI

Practice address

2654 S Oneida St Stop 102
Green Bay, WI 54304-5337

Phone

(888) 938-3838

NPI assigned

Nov 21, 2024

Last updated

Dec 13, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Tara Carstens Former name

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advanced Ear Nose and Throat Specialists, SCGroup PAC ID 9335106319, 33 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Advanced Ear Nose & Throat Specialists, SC

  dba Advent

  • Plastic Surgery within the Head & Neck (Otolaryngology) Physician
  • Wauwatosa, WI
  • NPI 1689782427
  Medicare reassignment Care Compare group NPD
• Advanced Ear Nose & Throat Specialists, SC

  dba Advent

  • Otolaryngology Physician
  • Miamisburg, OH
  • NPI 1811717887
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1732147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734048000000",
    "number": "1144045444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10001 W INNOVATION DR STE 200",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532264851",
            "telephone_number": "888-838-3838",
            "fax_number": "888-919-1083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2654 S ONEIDA ST STOP 102",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543045337",
            "telephone_number": "888-938-3838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "TARA",
        "credential": "APNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-11-21",
        "last_updated": "2024-12-13",
        "certification_date": "2024-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "15899-33",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WI",
            "license": "197282-30",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TARA",
            "last_name": "CARSTENS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jesse Frederick Peterson, PSYD
• Kristy A Peterson, CST
• Margaret Mary Peterson, OT
• Pebbles L Peterson, APSW
• Stephanie Marie Peterson, RN, BSN
• Rylee M Petit, OT
• Alisha Petrouske
• Eilis Petzke
• Nicholas Pflum
• Stephanie Philipp

• Nurse Practitioner in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Nurse Practitioner in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.