Healthcare Provider Details

I. General information

NPI: 1962908954
Provider Name (Legal Business Name): TARA JAWAD HAJARAT M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2018
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date: 12/07/2018
Reactivation Date: 02/18/2020

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

PO BOX 100275
GAINESVILLE FL
32610-0275
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-7839
  • Fax:
Mailing address:
  • Phone: 352-273-7839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberME152781
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: