Individual
TARA ASHLEY HOLLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
21990 HIGHWAY 62, SHADY COVE, OR 97539-9717
(541) 878-2022
Mailing address
PO BOX 508, SHADY COVE, OR 97539-0508
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
10009584
OR
363LF0000X
Family Nurse Practitioner
50884
WY
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
50884
WY
Other
Enumeration date
09/19/2022
Last updated
08/03/2023
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