| Doctor Name: | TARA N HARALDSON |
| NPI Number: | 1851727671 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PNP |
| License Number: | 741713 |
| Business Practice Address: | 136 El Chico Trl Ste 102 Willow Park, TX - 760878864 |
| Business Phone Number: | 8174415412 |
| Business Fax Number: | 8174419354 |
| Mailing Address: | Po Box 99371, FORT WORTH |
| State: | TX |
| Postal Code: | 761990371 |
| Phone Number: | 6828851855 |
| Fax Number: | 6828857347 |
| NPI Enumeration Date: | 09/25/2013 |
| NPI Last Update Date: | 09/25/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | 741713 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |