Individual
TARA N CLEMENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
5995 IRIS PARKWAY, BOX 189, FREDERICK, CO 80530
(303) 833-2050
(303) 833-9183
Mailing address
203 S ROLLIE AVE, FORT LUPTON, CO 80621-1508
(303) 286-4560
(303) 286-4589
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA.0002098
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
85584541
—
CO
Enumeration date
07/08/2006
Last updated
11/08/2013
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