Provider Demographics
NPI:1265792659
Name:EBBS, TARA (PA-C)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:EBBS
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6020 ERIN PARK DR # B-7
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-3428
Mailing Address - Country:US
Mailing Address - Phone:719-393-3001
Mailing Address - Fax:719-888-1557
Practice Address - Street 1:6020 ERIN PARK DR # B-7
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3428
Practice Address - Country:US
Practice Address - Phone:719-393-3001
Practice Address - Fax:719-888-1557
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-05412363A00000X
CAPA22213363A00000X
COPA0004975363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant