Provider Demographics
NPI:1659865533
Name:SELLNER, TARAH (FNP-C)
Entity type:Individual
Prefix:
First Name:TARAH
Middle Name:
Last Name:SELLNER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:TARAH
Other - Middle Name:
Other - Last Name:MCBEAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:3676 PARKER BLVD STE 260
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-2282
Mailing Address - Country:US
Mailing Address - Phone:719-553-2201
Mailing Address - Fax:833-916-2047
Practice Address - Street 1:3676 PARKER BLVD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-2212
Practice Address - Country:US
Practice Address - Phone:719-553-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0993727363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO14288871OtherCAQH