Provider Demographics
NPI:1689306219
Name:AUSTIN, TARA CHRISTENE ROVNEY (LVN)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:CHRISTENE ROVNEY
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 RYAN ST
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-4165
Mailing Address - Country:US
Mailing Address - Phone:949-899-3776
Mailing Address - Fax:
Practice Address - Street 1:628 RYAN ST
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-4165
Practice Address - Country:US
Practice Address - Phone:949-899-3776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA719771164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse