Tara Marie Ackerly, FNP
Individual provider Active NPI Family Nurse Practitioner · Danbury, CT
NPI 1831331602 · NPPES record last updated Sep 1, 2011
Key facts
- NPI
- 1831331602
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- F333573-1 (NY)
- Practice address
- 41 Germantown Rd Ste B05
Anticoagulation Center
Danbury, CT 06810-4087 - Phone
- (203) 739-7372
- NPI assigned
- Mar 25, 2009
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Trinity Health of New England Provider Network Organization Inc
Practice addresses (Care Compare)
56 Franklin St
Waterbury, CT 06706-1253
Phone (203) 709-6000
Hospital & facility affiliations
- Saint Mary'S Hospital
- Danbury Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140120000031 | CT | Practitioner - Nurse Practitioner | 0042448060 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3624 | CT | MD | Family Nurse Practitioner |
| F333573-1 | NY | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Trinity Health of New England Provider Network Organization Inc | Current |
Accepting new patients | |
| Trinity Health of New England Provider Network Organization Inc | Current |
Accepting new patients |
Locations
1300 Hall Blvd
Fl 3
Bloomfield, CT 06002
Phone (860) 714-2376
114 Woodland St
Hartford, CT 06105
Phone (860) 714-4001
33 Bullet Hill Rd
Ste 214
Southbury, CT 06488
Phone (203) 267-1563
Interoperability endpoints
- tackerly2381955@direct.trinity-health.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | F333573-1 | NY | Yes |
| Family Nurse Practitioner | 363LF0000X | 3624 | CT |
Addresses
Primary practice location
41 Germantown Rd Ste B05
Anticoagulation Center
Danbury, CT 06810-4087
Mailing address
41 Germantown Rd Ste B05
Anticoagulation Center
Danbury, CT 06810-4087
Phone (203) 739-7372
Other providers in Danbury, CT
- Ability Beyond Disability
- Ability Beyond Disability
- Ability Beyond Disability
- Martin Abrams
- Achieve Clarity Counseling LLC
- Peter Ackerman
- Action Chiropractic, LLC
- Kalvin Barcelona Adala
- Jacqueline Lucia Addona
- Aisha Olanike Adigun
All providers in Danbury, CT · Family Nurse Practitioner in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 1, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.