Provider Demographics
NPI:1336033273
Name:WOODRUFF, TARA MARIE (RN)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:MARIE
Last Name:WOODRUFF
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:MARIE
Other - Last Name:GVODAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2901 TELESTAR CT STE 300
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-1263
Mailing Address - Country:US
Mailing Address - Phone:703-573-3494
Mailing Address - Fax:703-766-5978
Practice Address - Street 1:11800 SUNRISE VALLEY DR STE 500
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-5316
Practice Address - Country:US
Practice Address - Phone:703-437-5977
Practice Address - Fax:703-478-2475
Is Sole Proprietor?:No
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001291205163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care