Provider Demographics
NPI:1669893699
Name:JEWELL, TARA (NP-C)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:JEWELL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3702 S TIMBERLINE RD
Mailing Address - Street 2:BLDG A
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3624
Mailing Address - Country:US
Mailing Address - Phone:970-212-0879
Mailing Address - Fax:970-484-8667
Practice Address - Street 1:3702 S TIMBERLINE RD
Practice Address - Street 2:BLDG A
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3624
Practice Address - Country:US
Practice Address - Phone:970-212-0879
Practice Address - Fax:970-484-8667
Is Sole Proprietor?:No
Enumeration Date:2013-12-17
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY340927363LG0600X
CO0992029363LG0600X
NY306752363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology