Provider Demographics
NPI:1619390325
Name:WOOD, TARA (CRNP)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:WOOD
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 1:28170 OLD VILLAGE RD
Mailing Address - Street 2:STE 102
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20659-4211
Mailing Address - Country:US
Mailing Address - Phone:240-249-6073
Mailing Address - Fax:240-248-6075
Practice Address - Street 1:28170 OLD VILLAGE RD
Practice Address - Street 2:STE 102
Practice Address - City:MECHANICSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20659-4211
Practice Address - Country:US
Practice Address - Phone:240-249-6073
Practice Address - Fax:240-249-6075
Is Sole Proprietor?:No
Enumeration Date:2014-01-31
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR153236363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily