Healthcare Provider Details

I. General information

NPI: 1265836233
Provider Name (Legal Business Name): KAREN TARVID
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2014
Last Update Date: 10/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1390 FORT PICKENS ROAD 212
GULF BREEZE FL
32561
US

IV. Provider business mailing address

1390 FT.PICKENS RD.#212
GULF BREEZE FL
32561
US

V. Phone/Fax

Practice location:
  • Phone: 850-293-9173
  • Fax:
Mailing address:
  • Phone: 850-293-9173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number913649
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number52768
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number8467
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: