Healthcare Provider Details

I. General information

NPI: 1639329766
Provider Name (Legal Business Name): TARA MARGARET GRANT MS, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2008
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 GRAND BOULEVARD SUITE 206
MIRAMAR BEACH FL
32550-1408
US

IV. Provider business mailing address

495 GRAND BOULEVARD SUITE 206
MIRAMAR BEACH FL
32550-1408
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax:
Mailing address:
  • Phone: 855-832-6727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-66340
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: