Provider Demographics
NPI:1043552797
Name:TARA, JANICE CHANDRA (ANP)
Entity Type:Individual
Prefix:MISS
First Name:JANICE
Middle Name:CHANDRA
Last Name:TARA
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 HEATHCOTE RD
Mailing Address - Street 2:ELMONT
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-1402
Mailing Address - Country:US
Mailing Address - Phone:516-328-9843
Mailing Address - Fax:
Practice Address - Street 1:3 HEATHCOTE RD
Practice Address - Street 2:3
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003
Practice Address - Country:US
Practice Address - Phone:516-328-9843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-20
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY#A1212034363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health