Healthcare Provider Details

I. General information

NPI: 1801952650
Provider Name (Legal Business Name): TARA HILLS L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7395 GULF BLVD
ST PETE BEACH FL
33706-1955
US

IV. Provider business mailing address

7395 GULF BLVD
ST PETE BEACH FL
33706-1955
US

V. Phone/Fax

Practice location:
  • Phone: 727-363-0772
  • Fax: 727-363-1703
Mailing address:
  • Phone: 727-363-0772
  • Fax: 727-363-1703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA00045175
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: