MEDICARE: TARA B ALTMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1205099272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA B ALTMAN

Provider Business Mailing Address
First Line	:	1763 MAIN ST APT 123F
Second Line	:
City	:	DUNEDIN
State	:	FL
Zip	:	34698-6407
Country	:	US
Telephone Number	:	727-366-3876
Fax Number	:

Provider Business Practice Location Address
First Line	:	2202 N WEST SHORE BLVD STE 140
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-5759
Country	:	US
Telephone Number	:	727-366-3876
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2008
Last Update Date	:	04/04/2018

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Directions to “ TARA B ALTMAN ” Practice Location

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