Healthcare Provider Details

I. General information

NPI: 1053436295
Provider Name (Legal Business Name): TARA SCHERER HALEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6225 BRANDON AVE STE 365
SPRINGFIELD VA
22150-2526
US

IV. Provider business mailing address

6225 BRANDON AVE STE 365
SPRINGFIELD VA
22150-2526
US

V. Phone/Fax

Practice location:
  • Phone: 571-642-3443
  • Fax:
Mailing address:
  • Phone: 571-642-3433
  • Fax: 855-998-8571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001214973
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0024167968
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024167968
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: