Doctor Name: | MS. SAVATRI TACK |
NPI Number: | 1053612788 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP |
License Number: | 207349 |
Business Practice Address: | 1200 Centre Street Department Of Medicine Roslindale, MA - 021311000 |
Business Phone Number: | 6173638010 |
Business Fax Number: | 6173638929 |
Mailing Address: | 1200 Centre Street, Department Of Medicine ROSLINDALE |
State: | MA |
Postal Code: | 021311000 |
Phone Number: | 6173638010 |
Fax Number: | 6173638929 |
NPI Enumeration Date: | 11/11/2010 |
NPI Last Update Date: | 07/02/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 207349 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |