Active NPI
Tara Danielle Nielsen, FNP-BC, APNP
- Family Nurse Practitioner
- Racine, WI
National Provider Identifier
1447687553
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 5430-33
- Practice address
- 2542 Wynfield Drive
Racine, WI 53406-1897 - Phone
- (262) 880-5359
- NPI assigned
- Oct 3, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 5430-33 | WI | Primary |
Addresses
Primary practice location
2542 Wynfield Drive
Racine, WI 53406-1897
Mailing address
3710 57TH Ave
Kenosha, WI 53144-4820
Phone (262) 880-5359
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5430-33 | WI | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1380758400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1476835200000",
"number": "1447687553",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3710 57TH AVE",
"city": "KENOSHA",
"state": "WI",
"postal_code": "531444820",
"telephone_number": "262-880-5359"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2542 WYNFIELD DRIVE",
"city": "RACINE",
"state": "WI",
"postal_code": "534061897",
"telephone_number": "262-880-5359"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NIELSEN",
"first_name": "TARA",
"middle_name": "DANIELLE",
"credential": "FNP-BC, APNP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-10-03",
"last_updated": "2016-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "WI",
"license": "5430-33",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Racine, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.