Provider Demographics
NPI:1265828230
Name:DEBARDELEBEN, TARA HELM (NP)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:HELM
Last Name:DEBARDELEBEN
Suffix:
Gender:
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:222 N 2ND ST
Mailing Address - Street 2:STE 204
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-6130
Mailing Address - Country:US
Mailing Address - Phone:415-658-6791
Mailing Address - Fax:
Practice Address - Street 1:2201 E CAMELBACK RD STE 101A
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-3495
Practice Address - Country:US
Practice Address - Phone:888-663-6331
Practice Address - Fax:415-252-7176
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZAP7738363LF0000X
COC-APN.0103406-C-NP363LF0000X
ID69134363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily