Provider Demographics
NPI:1306394499
Name:MCDONALD, TARA (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2414 AVALON TRACE LN
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-7582
Mailing Address - Country:US
Mailing Address - Phone:832-253-5819
Mailing Address - Fax:
Practice Address - Street 1:4801 WOODWAY DR
Practice Address - Street 2:#210W
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-1884
Practice Address - Country:US
Practice Address - Phone:713-936-2490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-16
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131246363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily