Provider Demographics
NPI:1710243225
Name:TARASOVA, INNA (MSN ACNP)
Entity Type:Individual
Prefix:MRS
First Name:INNA
Middle Name:
Last Name:TARASOVA
Suffix:
Gender:F
Credentials:MSN ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1606 WESTBURY DR
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23229-4831
Mailing Address - Country:US
Mailing Address - Phone:804-673-0780
Mailing Address - Fax:
Practice Address - Street 1:7740 SHRADER RD STE A
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23228-2500
Practice Address - Country:US
Practice Address - Phone:804-501-1600
Practice Address - Fax:804-501-2150
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024169153363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care