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General NPI Number Information
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NPI Number | 1013717446
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Entity Type | Individual
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Provider Name | TARA JUSTINE O'MALLEY NP
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Gender | Female
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Dates
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Enumeration Date | 03/14/2025
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 1745 SHEA CENTER DR. STE 400
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City | HIGHLANDS RANCH
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State | CO
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Zip | 80129
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Country | UM
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Telephone | 720-715-8474
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Fax |
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Provider Business Mailing Address
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Address Line | 1745 SHEA CENTER DR STE 400
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City | HIGHLANDS RANCH
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State | CO
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Zip | 80129-1540
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Country | US
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Telephone | 720-715-8474
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 1000665
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License Number State | CO
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