Healthcare Provider Details

I. General information

NPI: 1396453262
Provider Name (Legal Business Name): TARAH ANNIKA LAWSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2022
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 W GANDY BLVD
TAMPA FL
33611-2931
US

IV. Provider business mailing address

3606 SHADOW ARBOR WAY
LUTZ FL
33548-3500
US

V. Phone/Fax

Practice location:
  • Phone: 813-925-1903
  • Fax: 813-749-8370
Mailing address:
  • Phone: 813-679-0104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberAPRN11021141
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAPRN11021141
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11021141
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: