Provider Demographics
NPI:1184724833
Name:CHAVEZ, TARA K (RN)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:K
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:K
Other - Last Name:ORR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4721 S PUEBLO AVE
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85650
Mailing Address - Country:US
Mailing Address - Phone:520-803-0868
Mailing Address - Fax:
Practice Address - Street 1:100 SCHOOL DR
Practice Address - Street 2:HUACHUCA CITY SCHOOL
Practice Address - City:HUACHUCA CITY
Practice Address - State:AZ
Practice Address - Zip Code:85616
Practice Address - Country:US
Practice Address - Phone:520-456-9842
Practice Address - Fax:520-456-9811
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN106452163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ036384Medicaid