Provider Demographics
NPI:1326375452
Name:HENRY, TARA BETH (ANP)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:BETH
Last Name:HENRY
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16372 SANDPIPER DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99516-5053
Mailing Address - Country:US
Mailing Address - Phone:907-227-6654
Mailing Address - Fax:907-336-7862
Practice Address - Street 1:16372 SANDPIPER DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99516-5053
Practice Address - Country:US
Practice Address - Phone:907-227-6654
Practice Address - Fax:907-336-7862
Is Sole Proprietor?:No
Enumeration Date:2009-11-10
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily