Individual provider Active NPI

Courtney Tacvorian, FNP-BC

  • Family Nurse Practitioner
  • Lynn, MA
National Provider Identifier
1396094439
Registry record updated Jan 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN2269734 Issued in MA
Practice address
37 Friend St
Lynn, MA 01902
Phone
(978) 712-3360
NPI assigned
Sep 5, 2012
Last updated
Jan 7, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN2269734 MA Primary

Addresses

Primary practice location

37 Friend St
Lynn, MA 01902

Mailing address

37 Friend St
Lynn, MA 01902-3068
Phone (516) 581-6226

Other practice location 1

37 Friend St
Lynn, MA 01902
Phone (978) 712-3360

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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

Enrollment IDStateProvider typePAC IDDetails
I20150403000420 MA Order and Referring Only - Nurse Practitioner 0749507630

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
RN2269734MAMDFamily Nurse Practitioner

Interoperability endpoints

  • Direct secure messaging: courtney.tacvorian.p1@direct.elementcare.nextgenshare.com

NPI Registry JSON

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

{
    "created_epoch": "1346803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609977600000",
    "number": "1396094439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "37 FRIEND ST",
            "city": "LYNN",
            "state": "MA",
            "postal_code": "019023068",
            "telephone_number": "516-581-6226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "37 FRIEND ST",
            "city": "LYNN",
            "state": "MA",
            "postal_code": "01902",
            "telephone_number": "978-712-3360"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "37 Friend St",
            "address_purpose": "LOCATION",
            "city": "Lynn",
            "state": "MA",
            "postal_code": "01902",
            "country_code": "US",
            "telephone_number": "978-712-3360",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TACVORIAN",
        "first_name": "COURTNEY",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-05",
        "last_updated": "2021-01-07",
        "certification_date": "2021-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MA",
            "license": "RN2269734",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lynn, MA

Sources for this page

Verify at the official NPI Registry.