Healthcare Provider Details

I. General information

NPI: 1447536685
Provider Name (Legal Business Name): TARA TERESA FLORES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2011
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2177 W IRONWOOD CENTER DR
COEUR D ALENE ID
83814
US

IV. Provider business mailing address

2003 KOOTENAI HEALTH WAY
COEUR D ALENE ID
83814-6051
US

V. Phone/Fax

Practice location:
  • Phone: 208-625-6111
  • Fax: 208-625-6112
Mailing address:
  • Phone: 208-625-5059
  • Fax: 208-625-5731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP1684A
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: