Individual
MS. TARA LYNN DEA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, CRNP, PNP-BC
Contact information
Practice address
34TH ST & CIVIC CENTER BLVD, DEPARTMENT OF ENDOCRINOLOGY, PHILADELPHIA, PA 19104-4399
(215) 590-3174
Mailing address
172 LA COSTA DR, BLACKWOOD, NJ 08012-5546
(609) 332-5521
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
26NJ00306100
NJ
363LP0200X
Pediatric Nurse Practitioner
Primary
SP009251
PA
Other
Enumeration date
11/24/2006
Last updated
12/16/2014
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