Provider Demographics
NPI:1538299003
Name:FILBRUN, TARA ELIZABETH (RN)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:ELIZABETH
Last Name:FILBRUN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:ELIZABETH
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1540 FLORIDA AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4430
Mailing Address - Country:US
Mailing Address - Phone:209-544-3236
Mailing Address - Fax:209-577-8125
Practice Address - Street 1:1540 FLORIDA AVE
Practice Address - Street 2:STE 100
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4430
Practice Address - Country:US
Practice Address - Phone:209-544-3236
Practice Address - Fax:209-577-8125
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA632419163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse