Healthcare Provider Details

I. General information

NPI: 1275924094
Provider Name (Legal Business Name): TARYN K FABIAN ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2015
Last Update Date: 02/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1532 OAKFIELD DR SUITE A
BRANDON FL
33511-0829
US

IV. Provider business mailing address

1532 OAKFIELD DR SUITE A
BRANDON FL
33511-0829
US

V. Phone/Fax

Practice location:
  • Phone: 813-381-3852
  • Fax: 813-381-3873
Mailing address:
  • Phone: 813-381-3852
  • Fax: 813-381-3873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAL 3868
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: