MEDICARE: TARRANT FAMILY PRACTICE P.A

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1205806106
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TARRANT FAMILY PRACTICE P.A

Provider Business Mailing Address
First Line	:	251 WESTPARK WAY
Second Line	:	SUITE 200
City	:	EULESS
State	:	TX
Zip	:	76040-3742
Country	:	US
Telephone Number	:	682-236-3622
Fax Number	:	817-545-8952

Provider Business Practice Location Address
First Line	:	4504 BOAT CLUB RD
Second Line	:	SUITE 800
City	:	FORT WORTH
State	:	TX
Zip	:	76135-7003
Country	:	US
Telephone Number	:	817-237-0515
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	MISS BRIDGETT ANDERSON
Credential	:
Telephone Number	:	682-236-3622

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	03/09/2015

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