MEDICARE: TARA SUAREZ FNP

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	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	APRN9340061	FL
2	363LF0000X	Family Nurse Practitioner	APRN9340061	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528474988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA SUAREZ FNP

Provider Business Mailing Address
First Line	:	PO BOX 2147
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33902-2147
Country	:	US
Telephone Number	:	239-343-6100
Fax Number	:	239-343-9727

Provider Business Practice Location Address
First Line	:	4761 S CLEVELAND AVE STE 4
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-1375
Country	:	US
Telephone Number	:	239-343-6100
Fax Number	:	239-343-9727

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

Provider Enumeration Date	:	07/07/2014
Last Update Date	:	04/08/2026

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