Healthcare Provider Details

I. General information

NPI: 1013630797
Provider Name (Legal Business Name): TARA ASHLEY HOLLEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TARA ASHLEY COX RN

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 HAWTHORNE ST
MEDFORD OR
97504-7114
US

IV. Provider business mailing address

26 HAWTHORNE ST
MEDFORD OR
97504-7114
US

V. Phone/Fax

Practice location:
  • Phone: 541-215-4177
  • Fax: 303-484-6316
Mailing address:
  • Phone: 541-215-4177
  • Fax: 303-484-6316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10009584
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: