Provider Demographics
NPI:1699318477
Name:MCGOVERN, TARA A (NP-C)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:A
Last Name:MCGOVERN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6759 RAINIER RD
Mailing Address - Street 2:
Mailing Address - City:TIMNATH
Mailing Address - State:CO
Mailing Address - Zip Code:80547-6702
Mailing Address - Country:US
Mailing Address - Phone:609-922-6348
Mailing Address - Fax:
Practice Address - Street 1:5200 HAHNS PEAK DR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-8852
Practice Address - Country:US
Practice Address - Phone:970-962-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-23
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0995125-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily