Provider Demographics
NPI:1912777368
Name:HENLEY, TARA DENISE (NP)
Entity Type:Individual
Prefix:MISS
First Name:TARA
Middle Name:DENISE
Last Name:HENLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3409 HENRY HARFORD DR
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-1130
Mailing Address - Country:US
Mailing Address - Phone:443-865-4951
Mailing Address - Fax:
Practice Address - Street 1:3409 HENRY HARFORD DR
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009-1130
Practice Address - Country:US
Practice Address - Phone:144-386-5495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR164422363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health