| Doctor Name: | MRS. TARA ROSS |
| NPI Number: | 1396119939 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CNP |
| License Number: | 18394 |
| Business Practice Address: | 292 Brooks Malott Rd Mount Orab, OH - 451549580 |
| Business Phone Number: | 9374440035 |
| Business Fax Number: | |
| Mailing Address: | 311 Deer Creek Dr, AMELIA |
| State: | OH |
| Postal Code: | 451022684 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 11/19/2015 |
| NPI Last Update Date: | 12/29/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | 18394 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |