Provider Demographics
NPI:1558627141
Name:CALLOW, TARA COURTNEY (CRNP)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:COURTNEY
Last Name:CALLOW
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 S CHERRY ST STE 410
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-2664
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:950 S CHERRY ST STE 410
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-2664
Practice Address - Country:US
Practice Address - Phone:720-515-5577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-08
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COC-RXN.0100260-C-NP363LP0808X
ZZL-15798163WL0100X
FLAPRN11016172363LP0808X
NYF382246363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant