Provider Demographics
NPI:1326114281
Name:DEA, TARA LYNN (MSN, CRNP, PNP-BC)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:LYNN
Last Name:DEA
Suffix:
Gender:F
Credentials:MSN, CRNP, PNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 LA COSTA DR
Mailing Address - Street 2:
Mailing Address - City:BLACKWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-5546
Mailing Address - Country:US
Mailing Address - Phone:609-332-5521
Mailing Address - Fax:
Practice Address - Street 1:34TH ST & CIVIC CENTER BLVD
Practice Address - Street 2:DEPARTMENT OF ENDOCRINOLOGY
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4399
Practice Address - Country:US
Practice Address - Phone:215-590-3174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009251363LP0200X
NJ26NJ00306100363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics