Provider Demographics
NPI:1801330857
Name:ELLIOTT, TARA A (RN)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:A
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TARA MARIE
Other - Middle Name:A
Other - Last Name:ELLIOTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1691 THE ALAMEDA
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2203
Mailing Address - Country:US
Mailing Address - Phone:408-795-3619
Mailing Address - Fax:
Practice Address - Street 1:316 N MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-2872
Practice Address - Country:US
Practice Address - Phone:831-758-8261
Practice Address - Fax:831-783-6314
Is Sole Proprietor?:No
Enumeration Date:2016-12-09
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA815039163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse