| Doctor Name: | KIMBERLY TALLIA |
| NPI Number: | 1144635517 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NURSE PRACTITIONER |
| License Number: | 26NJ00488700 |
| Business Practice Address: | 142 Route 35 Suite 103 Eatontown, NJ - 077241876 |
| Business Phone Number: | 7323895004 |
| Business Fax Number: | 7323891850 |
| Mailing Address: | 142 Route 35, Suite 103 EATONTOWN |
| State: | NJ |
| Postal Code: | 077241876 |
| Phone Number: | 7323895004 |
| Fax Number: | 7323891850 |
| NPI Enumeration Date: | 06/24/2014 |
| NPI Last Update Date: | 06/24/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 26NJ00488700 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |