Healthcare Provider Details

I. General information

NPI: 1891928354
Provider Name (Legal Business Name): TARA CLEMENTS CONTI RN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TARA WATKINS CLEMENTS RN

II. Dates (important events)

Enumeration Date: 09/01/2009
Last Update Date: 10/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 S MANGUM ST
DURHAM NC
27701-3904
US

IV. Provider business mailing address

118 AMIABLE LOOP
CARY NC
27519-5566
US

V. Phone/Fax

Practice location:
  • Phone: 919-683-1607
  • Fax:
Mailing address:
  • Phone: 703-509-9459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00245700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5005826
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: