Individual
TARA MAHON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
263 FARMINGTON AVE, FARMINGTON, CT 06030-0001
(860) 679-2000
Mailing address
5 RIVERBEND LN, COLLINSVILLE, CT 06019-3418
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
8488
CT
363LP2300X
Primary Care Nurse Practitioner
Primary
008488
CT
Other
Enumeration date
10/22/2019
Last updated
11/25/2019
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