Provider Demographics
NPI:1013674621
Name:ADAMS, TARA (MSPAS, PA-C)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:ADAMS
Suffix:
Gender:
Credentials:MSPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2749 WALNUT ST APT 419
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-2078
Mailing Address - Country:US
Mailing Address - Phone:610-295-9054
Mailing Address - Fax:
Practice Address - Street 1:4743 ARAPAHOE AVE STE 202
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1128
Practice Address - Country:US
Practice Address - Phone:303-938-5700
Practice Address - Fax:303-998-0007
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0007078363AS0400X
CO0007078363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant