Healthcare Provider Details

I. General information

NPI: 1053915637
Provider Name (Legal Business Name): TARA MANON HOFFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2020
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2464 NW 95TH WAY
CORAL SPRINGS FL
33065-4900
US

IV. Provider business mailing address

2464 NW 95TH WAY
CORAL SPRINGS FL
33065-4900
US

V. Phone/Fax

Practice location:
  • Phone: 954-459-0772
  • Fax:
Mailing address:
  • Phone: 954-459-0772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberPS44025
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS44025
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: