MEDICARE: MRS. TARA MARIE ICE NNP

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	363LP1700X	Perinatal Nurse Practitioner	11045463	FL

General Provider Information

NPI Number	:	1356207930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TARA MARIE ICE NNP

Provider Business Mailing Address
First Line	:	1301 CONCORD TER
Second Line	:
City	:	SUNRISE
State	:	FL
Zip	:	33323-2843
Country	:	US
Telephone Number	:	954-692-7615
Fax Number	:

Provider Business Practice Location Address
First Line	:	3001 W DR MARTIN LUTHER KING JR BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6307
Country	:	US
Telephone Number	:	813-872-2929
Fax Number	:

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

Provider Enumeration Date	:	12/29/2025
Last Update Date	:	02/12/2026

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