Provider Demographics
NPI:1891928354
Name:CONTI, TARA CLEMENTS (RN, FNP)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:CLEMENTS
Last Name:CONTI
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:MISS
Other - First Name:TARA
Other - Middle Name:WATKINS
Other - Last Name:CLEMENTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:118 AMIABLE LOOP
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-5566
Mailing Address - Country:US
Mailing Address - Phone:703-509-9459
Mailing Address - Fax:
Practice Address - Street 1:705 S MANGUM ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-3904
Practice Address - Country:US
Practice Address - Phone:919-683-1607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-01
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00245700363LF0000X
NC5005826363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily