Provider Demographics
NPI:1144737123
Name:CAMPO, TARA A (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:A
Last Name:CAMPO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:A
Other - Last Name:HALLIDAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:400 RIVERSIDE DR STE 2100
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-5004
Mailing Address - Country:US
Mailing Address - Phone:815-935-2784
Mailing Address - Fax:815-935-5687
Practice Address - Street 1:400 RIVERSIDE DR STE 2100
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-5004
Practice Address - Country:US
Practice Address - Phone:815-935-2784
Practice Address - Fax:815-935-5687
Is Sole Proprietor?:No
Enumeration Date:2017-12-29
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.017017363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily