Healthcare Provider Details

I. General information

NPI: 1720793466
Provider Name (Legal Business Name): TARA ASHLYN LAW APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TARA ASHLYN BRUMBLE APRN

II. Dates (important events)

Enumeration Date: 01/17/2023
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2946 E BANNER GATEWAY DR
GILBERT AZ
85234-2165
US

IV. Provider business mailing address

2946 E BANNER GATEWAY DR
GILBERT AZ
85234-2165
US

V. Phone/Fax

Practice location:
  • Phone: 918-521-0492
  • Fax:
Mailing address:
  • Phone: 480-256-6444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR0135424
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number220664
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number341519
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: