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General NPI Number Information
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NPI Number | 1609910132
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Entity Type | Individual
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Provider Name | TARA RAE ASHWORTH MS, NP
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Gender | Female
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Dates
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Enumeration Date | 02/17/2007
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 2100 EMMANUEL WAY SUITE B
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City | SPRINGFIELD
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State | OH
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Zip | 45502-7217
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Country | US
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Telephone | 937-398-0020
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Fax | 937-398-0021
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Provider Business Mailing Address
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Address Line | 2100 EMMANUEL WAY STE B
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City | SPRINGFIELD
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State | OH
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Zip | 45502-7217
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Country | US
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Telephone | 937-398-0020
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Fax | 937-398-0021
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN.CNP.09226
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NP-09226
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License Number State | OH
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