Provider Demographics
NPI:1427404631
Name:ROBINSON, TARA
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:ROBINSON
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 1:3940 SCOTT ROBINSON BLVD APT 1017
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-7862
Mailing Address - Country:US
Mailing Address - Phone:702-461-5064
Mailing Address - Fax:
Practice Address - Street 1:3940 SCOTT ROBINSON BLVD APT 1017
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-7862
Practice Address - Country:US
Practice Address - Phone:702-461-5064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-05
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
NVNV20161267987374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide