Provider Demographics
NPI:1992035778
Name:SANDS, TARA L (DNP)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:L
Last Name:SANDS
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:L
Other - Last Name:HYTREK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP
Mailing Address - Street 1:7261 MERCY RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3135 W BROADWAY
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501
Practice Address - Country:US
Practice Address - Phone:712-328-9100
Practice Address - Fax:712-328-0095
Is Sole Proprietor?:No
Enumeration Date:2009-12-30
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111084363L00000X
IAA123906363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner