Provider Demographics
NPI:1720390750
Name:HILLIARD, TARA C (ACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:C
Last Name:HILLIARD
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:C
Other - Last Name:HILLIARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ACNP-BC
Mailing Address - Street 1:301 40TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79404-2746
Mailing Address - Country:US
Mailing Address - Phone:806-743-9355
Mailing Address - Fax:806-743-9363
Practice Address - Street 1:301 40TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79404-2746
Practice Address - Country:US
Practice Address - Phone:806-743-9355
Practice Address - Fax:806-743-9363
Is Sole Proprietor?:No
Enumeration Date:2010-07-07
Last Update Date:2019-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP113736363LA2100X
TX652289363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health