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NPI Code Detail

MEDICARE: TARA ELIZABETH CHANEY FNP-C

MEDICARE: TARA ELIZABETH CHANEY FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner26NJ00720700NJ
2363LP2300XPrimary Care Nurse PractitionerRN295563GA

General Provider Information

NPI Number : 1952833543
Entity Type Code : Individual
Provider Name (Legal Business Name) : TARA ELIZABETH CHANEY FNP-C
Provider Business Mailing Address
First Line : 736 W BANKHEAD HWY
Second Line :
City : VILLA RICA
State : GA
Zip : 30180-1501
Country : US
Telephone Number : 866-389-2727
Fax Number :
Provider Business Practice Location Address
First Line : 736 W BANKHEAD HWY
Second Line :
City : VILLA RICA
State : GA
Zip : 30180-1501
Country : US
Telephone Number : 866-389-2727
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/01/2017
Last Update Date : 08/07/2024

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