Provider Demographics
NPI:1093340630
Name:TYE, TARA BETH (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:BETH
Last Name:TYE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:739 BRANDONTOWN RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355-7623
Mailing Address - Country:US
Mailing Address - Phone:931-581-4025
Mailing Address - Fax:
Practice Address - Street 1:100 WILLIAM NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-4754
Practice Address - Country:US
Practice Address - Phone:931-454-0489
Practice Address - Fax:931-454-1227
Is Sole Proprietor?:No
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27241363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily