Provider Demographics
NPI:1962860999
Name:MAHONEY, TARA (NP-C)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 E THOMAS RD
Mailing Address - Street 2:A-104
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7646
Mailing Address - Country:US
Mailing Address - Phone:602-845-4445
Mailing Address - Fax:
Practice Address - Street 1:2350 E GERMANN RD
Practice Address - Street 2:STE 31
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-1579
Practice Address - Country:US
Practice Address - Phone:480-878-5306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-04
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8397363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily