Provider Demographics
NPI:1356082499
Name:COADY, TARA NICOLE
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:NICOLE
Last Name:COADY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 BAYSHORE DR
Mailing Address - Street 2:
Mailing Address - City:LODA
Mailing Address - State:IL
Mailing Address - Zip Code:60948-9738
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1106 REYNOLDS ST STE 100
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-4376
Practice Address - Country:US
Practice Address - Phone:704-289-5443
Practice Address - Fax:704-283-7655
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program