Healthcare Provider Details

I. General information

NPI: 1770834871
Provider Name (Legal Business Name): TARA M ELROD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2012
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27450 YNEZ RD STE 100
TEMECULA CA
92591-4649
US

IV. Provider business mailing address

27450 YNEZ RD STE 100
TEMECULA CA
92591-4649
US

V. Phone/Fax

Practice location:
  • Phone: 858-315-4122
  • Fax:
Mailing address:
  • Phone: 858-315-4122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95032277
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: