Provider Demographics
NPI:1346735842
Name:GALLAWAY, TARA LEIGH (FNP-C)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:LEIGH
Last Name:GALLAWAY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:LEIGH
Other - Last Name:TERRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8533 TENON DR APT 5106
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76177-8094
Mailing Address - Country:US
Mailing Address - Phone:757-389-1292
Mailing Address - Fax:
Practice Address - Street 1:4500 S LANCASTER RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-7167
Practice Address - Country:US
Practice Address - Phone:214-742-8387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COC-RXN.0100240-C-NP363LF0000X
NC5010665363LF0000X
COC-APN.0100334-C-NP363LF0000X
TX1110293363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily