Provider Demographics
NPI:1043583248
Name:ELTON, TARA MICHELLE (RN)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:MICHELLE
Last Name:ELTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6178 WIGEON CT
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-9533
Mailing Address - Country:US
Mailing Address - Phone:614-282-2195
Mailing Address - Fax:
Practice Address - Street 1:6178 WIGEON CT
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-9533
Practice Address - Country:US
Practice Address - Phone:614-282-2195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH369098163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse