Provider Demographics
NPI:1396028379
Name:ASHBURN, TARA ALEXIS (BS)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:ALEXIS
Last Name:ASHBURN
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1731 NW 6TH ST
Mailing Address - Street 2:SUITE A1
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-8554
Mailing Address - Country:US
Mailing Address - Phone:352-264-8152
Mailing Address - Fax:352-375-6402
Practice Address - Street 1:1731 NW 6TH ST
Practice Address - Street 2:SUITE A1
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-8554
Practice Address - Country:US
Practice Address - Phone:352-264-8152
Practice Address - Fax:352-375-6402
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management