Individual
TARA MENDOZZA DECRESCENTIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C.
Contact information
Practice address
10099 RIDGEGATE PKWY STE 480, LONE TREE, CO 80124-5537
(720) 441-4021
(720) 360-1195
Mailing address
PO BOX 172263, DENVER, CO 80217-2263
(303) 306-7783
(303) 306-7753
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
2368
CO
363AM0700X
Medical Physician Assistant
Primary
2368
CO
363AS0400X
Surgical Physician Assistant
2368
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2368
LICENSE
CO
Enumeration date
03/24/2007
Last updated
03/17/2018
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