Provider Demographics
NPI:1871364760
Name:RHODES, TARA LYN (DNP, FNP-BC)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:LYN
Last Name:RHODES
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 28
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:UT
Mailing Address - Zip Code:84334-0028
Mailing Address - Country:US
Mailing Address - Phone:435-279-4176
Mailing Address - Fax:
Practice Address - Street 1:MARRIOTT HEALTH BUILDING 3875 STADIUM WAY DEPT 3903
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84408-0001
Practice Address - Country:US
Practice Address - Phone:435-279-4176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-10
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7677239-3102163W00000X
UT7677239-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse