Tara Forstie, NP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

AP8273 Issued in AZ

Practice address

19829 N 27TH Ave
Phoenix, AZ 85027-4001

Phone

(602) 769-1137

NPI assigned

Oct 13, 2015

Last updated

Mar 27, 2023By 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 5

Addresses

Other names 1

• Tara J Fredrickson Former name

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• 303 Emergency Physicians PLLC

  • Emergency Medicine Physician
  • Yuma, AZ
  • NPI 1518398585
  Medicare reassignment NPD
• Emcare - PNX Emergency Physicians LLC

  • Emergency Medicine Physician
  • Phoenix, AZ
  • NPI 1902855992
  Medicare reassignment NPD
• Loop 101 Emergency Physicians LLC

  • Emergency Medicine Physician
  • Phoenix, AZ
  • NPI 1376573378
  Medicare reassignment NPD
• Mobile Mendy LLC

  • Pediatric Nurse Practitioner
  • Anthem, AZ
  • NPI 1770251068

  Acute Care

  NPD Authorized official

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

{
    "created_epoch": "1444694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679875200000",
    "number": "1285005470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 E CAREFREE HWY # 299",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850858839",
            "telephone_number": "602-769-1137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19829 N 27TH AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850274001",
            "telephone_number": "602-769-1137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORSTIE",
        "first_name": "TARA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-10-13",
        "last_updated": "2023-03-27",
        "certification_date": "2021-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "AZ",
            "license": "RN00000099202",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "CO",
            "license": "1161",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "ND",
            "license": "R53837",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MN",
            "license": "9886",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "AZ",
            "license": "AP8273",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TARA",
            "last_name": "FREDRICKSON",
            "middle_name": "J",
            "credential": "NP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sumediah Nzuonkwelle Forsac, MD
• Russell G. Forsberg, PA-C
• Shannon Forshey, MD
• Kayla Forster
• Janine Paulette Forstie, RN, BSN, IBCLC
• Tara Forstrom, OTR/L
• Forte Physical Therapy LLC
• Yvonne T. Fortier, MA, LPC, LISAC
• Andrew Fortin, MD
• Patricia Fortin

• Pediatric Nurse Practitioner in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Pediatric Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.