Provider Demographics
NPI:1639986524
Name:CORWELL, TARA
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:CORWELL
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 1:600 JULIAN LN STE 640
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-7812
Mailing Address - Country:US
Mailing Address - Phone:828-552-3504
Mailing Address - Fax:828-552-3505
Practice Address - Street 1:600 JULIAN LN STE 640
Practice Address - Street 2:
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-7812
Practice Address - Country:US
Practice Address - Phone:828-552-3504
Practice Address - Fax:828-552-3505
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-13
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program