Provider Demographics
NPI:1679638514
Name:SPEARS, TARA O (MSN, RN, CCNS, CEN)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:O
Last Name:SPEARS
Suffix:
Gender:F
Credentials:MSN, RN, CCNS, CEN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7401 BLACKMON RD APT 2806
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-7524
Mailing Address - Country:US
Mailing Address - Phone:706-221-3453
Mailing Address - Fax:706-544-2144
Practice Address - Street 1:EMERGENCY DEPARTMENT, MARTIN ARMY COMMUNITY HOSPITAL
Practice Address - Street 2:BLDG 9200
Practice Address - City:FT. BENNING
Practice Address - State:GA
Practice Address - Zip Code:31905
Practice Address - Country:US
Practice Address - Phone:706-544-3398
Practice Address - Fax:706-544-2144
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001187871163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency