Healthcare Provider Details

I. General information

NPI: 1528474988
Provider Name (Legal Business Name): TARA SUAREZ FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2014
Last Update Date: 03/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 NORTHPOINT PKWY STE 200
WEST PALM BEACH FL
33407
US

IV. Provider business mailing address

770 NORTHPOINT PKWY STE 102
WEST PALM BEACH FL
33407-1901
US

V. Phone/Fax

Practice location:
  • Phone: 561-655-3331
  • Fax: 561-655-3744
Mailing address:
  • Phone: 561-275-7604
  • Fax: 561-802-5385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN151120
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN9340061
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAPRN9340061
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: