Provider Demographics
NPI:1659618239
Name:ELKINS, TARA A (PA-C)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:A
Last Name:ELKINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:A
Other - Last Name:MAHONEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:12769 FAIR CREST CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-3840
Mailing Address - Country:US
Mailing Address - Phone:703-901-3410
Mailing Address - Fax:
Practice Address - Street 1:4094 MAJESTIC LN
Practice Address - Street 2:PMB: #298
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-2104
Practice Address - Country:US
Practice Address - Phone:703-631-1745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-15
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110004119363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant