Provider Demographics
NPI:1184809451
Name:STRICKLAND, TARA MARIE (CRNA)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:MARIE
Last Name:STRICKLAND
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:TARA
Other - Middle Name:MARIE
Other - Last Name:KENNERLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:146 MEDICAL PARK RD 108
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8529
Mailing Address - Country:US
Mailing Address - Phone:704-662-0877
Mailing Address - Fax:704-662-0875
Practice Address - Street 1:146 MEDICAL PARK RD 108
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8529
Practice Address - Country:US
Practice Address - Phone:704-662-0877
Practice Address - Fax:704-662-0875
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC158606163W00000X
NC078254367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8053115Medicaid
NC2606277Medicare UPIN