Provider Demographics
NPI:1235948480
Name:BUSTOS, TARA CELESTE (CRNP)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:CELESTE
Last Name:BUSTOS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 SIVLEY RD SW STE 300
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5102
Mailing Address - Country:US
Mailing Address - Phone:256-762-6312
Mailing Address - Fax:
Practice Address - Street 1:201 SIVLEY RD SW STE 300
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5102
Practice Address - Country:US
Practice Address - Phone:256-762-6312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-168820363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care