Provider Demographics
NPI:1922565845
Name:TARR, DESIREE EVON (CRNP)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:EVON
Last Name:TARR
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:SELINSGROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17870-1651
Mailing Address - Country:US
Mailing Address - Phone:570-847-3471
Mailing Address - Fax:
Practice Address - Street 1:201 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-7969
Practice Address - Country:US
Practice Address - Phone:570-374-0151
Practice Address - Fax:570-374-0311
Is Sole Proprietor?:No
Enumeration Date:2019-02-27
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP020067363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily