Provider Demographics
NPI:1205329075
Name:JONES, TARA
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1188 BIG BETHEL RD # 125
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-1906
Mailing Address - Country:US
Mailing Address - Phone:704-533-1841
Mailing Address - Fax:877-573-6649
Practice Address - Street 1:760 CHICKAHOMINY LOOP APT 201
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:VA
Practice Address - Zip Code:23314-4069
Practice Address - Country:US
Practice Address - Phone:877-573-6649
Practice Address - Fax:877-573-6649
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care