Provider Demographics
NPI:1013717446
Name:O'MALLEY, TARA JUSTINE (NP)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:JUSTINE
Last Name:O'MALLEY
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1745 SHEA CENTER DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-1540
Mailing Address - Country:US
Mailing Address - Phone:720-715-8474
Mailing Address - Fax:
Practice Address - Street 1:1745 SHEA CENTER DR.
Practice Address - Street 2:STE 400
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129
Practice Address - Country:UM
Practice Address - Phone:720-715-8474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-14
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1000665363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health