Healthcare Provider Details

I. General information

NPI: 1952879736
Provider Name (Legal Business Name): TARA JILL PRINTZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TARA JILL HEROUX APRN

II. Dates (important events)

Enumeration Date: 11/09/2018
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 FOWLER ST STE 2
FORT MYERS FL
33901-2600
US

IV. Provider business mailing address

PO BOX 100 DEPT#394
MEMPHIS TN
38148-0001
US

V. Phone/Fax

Practice location:
  • Phone: 239-837-8187
  • Fax: 855-576-5116
Mailing address:
  • Phone: 941-300-4440
  • Fax: 941-404-1760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11000058
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: