Provider Demographics
NPI:1598213134
Name:SCHULTZ, TARA L (APRN)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:L
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5300 N INDEPENDENCE AVE STE 280
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5555
Mailing Address - Country:US
Mailing Address - Phone:405-357-3500
Mailing Address - Fax:405-357-3519
Practice Address - Street 1:7301 SW 44TH ST STE A
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73179-4309
Practice Address - Country:US
Practice Address - Phone:405-357-3500
Practice Address - Fax:405-357-3519
Is Sole Proprietor?:No
Enumeration Date:2016-09-12
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK74108363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily