| Doctor Name: | MRS. TARA M. COYNE |
| NPI Number: | 1184972333 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | 273636 |
| Business Practice Address: | 600 Clark Rd 2nd Floor Tewksbury, MA - 018761699 |
| Business Phone Number: | 9784586900 |
| Business Fax Number: | 9784581670 |
| Mailing Address: | 600 Clark Rd, 2nd Floor TEWKSBURY |
| State: | MA |
| Postal Code: | 018761699 |
| Phone Number: | 9784586900 |
| Fax Number: | 9784581670 |
| NPI Enumeration Date: | 08/20/2012 |
| NPI Last Update Date: | 08/20/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 273636 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |