Provider Demographics
NPI:1265828230
Name:DEBARDELEBEN, TARA HELM (NP)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:HELM
Last Name:DEBARDELEBEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:222 N 2ND ST
Mailing Address - Street 2:STE 204
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-6130
Mailing Address - Country:US
Mailing Address - Phone:415-658-6791
Mailing Address - Fax:
Practice Address - Street 1:2201 E CAMELBACK RD STE 101A
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-3495
Practice Address - Country:US
Practice Address - Phone:602-218-4075
Practice Address - Fax:415-291-0489
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ID69134363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily