Provider Demographics
NPI:1265065270
Name:ROCHLEAU, TARA ANN
Entity type:Individual
Prefix:MS
First Name:TARA
Middle Name:ANN
Last Name:ROCHLEAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:ANN
Other - Last Name:HUDSPETH, STEBURG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1316 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLARION
Mailing Address - State:IA
Mailing Address - Zip Code:50525-2019
Mailing Address - Country:US
Mailing Address - Phone:515-602-9833
Mailing Address - Fax:319-343-1161
Practice Address - Street 1:840 W US HIGHWAY 18
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:IA
Practice Address - Zip Code:50438-1023
Practice Address - Country:US
Practice Address - Phone:641-925-1500
Practice Address - Fax:641-925-1507
Is Sole Proprietor?:No
Enumeration Date:2020-02-18
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA157954363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily