Provider Demographics
NPI:1821481706
Name:JEFFERY, TARA (RN)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:JEFFERY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 N BLANCHE ST
Mailing Address - Street 2:
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-2517
Mailing Address - Country:US
Mailing Address - Phone:805-640-0300
Mailing Address - Fax:
Practice Address - Street 1:512 N BLANCHE ST
Practice Address - Street 2:
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023-2517
Practice Address - Country:US
Practice Address - Phone:805-640-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-16
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN531743163WP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0000XNursing Service ProvidersRegistered NursePain Management