Provider Demographics
NPI:1730355173
Name:ABBONDANZA, TARA M (NP)
Entity type:Individual
Prefix:MS
First Name:TARA
Middle Name:M
Last Name:ABBONDANZA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:TARA
Other - Middle Name:M
Other - Last Name:HUGHES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 80011
Mailing Address - Street 2:
Mailing Address - City:CITY OF INDUSTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91716-8011
Mailing Address - Country:US
Mailing Address - Phone:267-932-8856
Mailing Address - Fax:626-793-6262
Practice Address - Street 1:289 W HUNTINGTON DR STE 401
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-3493
Practice Address - Country:US
Practice Address - Phone:626-254-0074
Practice Address - Fax:626-254-0079
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13616363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0376694OtherANCC
CA13616OtherBRN