Healthcare Provider Details

I. General information

NPI: 1801184684
Provider Name (Legal Business Name): TARA DEVOY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2011
Last Update Date: 10/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 EXTON SQUARE MALL
EXTON PA
19341-2440
US

IV. Provider business mailing address

154 EXTON SQUARE MALL
EXTON PA
19341-2440
US

V. Phone/Fax

Practice location:
  • Phone: 484-876-2160
  • Fax: 484-876-2164
Mailing address:
  • Phone: 484-876-2160
  • Fax: 484-876-2164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP018930
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN585724
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: