Tarah Tracy Thevenot

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

C-APN.0002436-C-NP Issued in CO

Practice address

1702 E Pikes Peak Ave
Colorado Springs, CO 80909-5717

Phone

(719) 358-7338

NPI assigned

Aug 26, 2020

Last updated

Nov 5, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1598400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636070400000",
    "number": "1275146524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1702 E PIKES PEAK AVE",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809095717",
            "telephone_number": "719-358-7338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1702 E PIKES PEAK AVE",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809095717",
            "telephone_number": "719-358-7338"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4238 NE 29th Pl",
            "address_purpose": "LOCATION",
            "city": "Ocala",
            "state": "FL",
            "postal_code": "344703366",
            "country_code": "US",
            "telephone_number": "352-233-8577",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THEVENOT",
        "first_name": "TARAH",
        "middle_name": "TRACY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-08-26",
        "last_updated": "2021-11-05",
        "certification_date": "2021-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CO",
            "license": "C-APN.0002436-C-NP",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11008733",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "11008733",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Therapywize LLC (TherapyWize)
• Therasynthesis, LLC
• Theresa M. Gisi, LLC
• Marisol Theriot
• Thomas Warren Theune, O.D.
• Katharine D Theys
• Thh358 LLC
• Tyrone Kunta Thibou
• Kimmberly J Thiel, PA
• Mary Thiel

• Nurse Practitioner in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• Nurse Practitioner in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.