Provider Demographics
NPI:1801083209
Name:JUSTIS, TARI LYNN (APN)
Entity type:Individual
Prefix:MISS
First Name:TARI
Middle Name:LYNN
Last Name:JUSTIS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 N ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-4505
Mailing Address - Country:US
Mailing Address - Phone:775-329-6241
Mailing Address - Fax:775-324-6549
Practice Address - Street 1:645 N ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-4505
Practice Address - Country:US
Practice Address - Phone:775-329-6241
Practice Address - Fax:775-324-6549
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV00210364SW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SW0102XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistWomen's Health