Healthcare Provider Details

I. General information

NPI: 1174732051
Provider Name (Legal Business Name): TARA CALABRESE MASSINI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TARA MICHELLE CALABRESE MD

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 08/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD DEPARTMENT OF RADIOLOGY, BOX 100374
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

1601 SW ARCHER RD NF/SG VAMC DEPARTMENT OF RADIOLOGY
GAINESVILLE FL
32608-1135
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0291
  • Fax:
Mailing address:
  • Phone: 352-376-1611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberTRN11157
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME 109703
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: