Provider Demographics
NPI:1104110873
Name:JONES, TARA RENEE (CARE PROVIDER)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:RENEE
Last Name:JONES
Suffix:
Gender:F
Credentials:CARE PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 CLAREMONT DR
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-2901
Mailing Address - Country:US
Mailing Address - Phone:870-918-0466
Mailing Address - Fax:
Practice Address - Street 1:401 CLAREMONT DR
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-2901
Practice Address - Country:US
Practice Address - Phone:870-918-0466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3747A0650X3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider