Provider Demographics
NPI:1861025256
Name:CANDELA, TARA (APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:CANDELA
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1975 NW 167TH PL STE 100-20
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-4908
Mailing Address - Country:US
Mailing Address - Phone:503-874-6463
Mailing Address - Fax:503-831-8947
Practice Address - Street 1:10714 NE GLISAN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-4046
Practice Address - Country:US
Practice Address - Phone:503-645-3581
Practice Address - Fax:971-288-1331
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-13
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201609336RN163WP0808X
WARN61084371163WP0809X
WAAP61144096363LP0808X
390200000X
OR202101319NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program