Healthcare Provider Details

I. General information

NPI: 1891848560
Provider Name (Legal Business Name): TARA C HOLT MSN,APRN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 02/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6799 GREAT OAKS RD SUITE 250
MEMPHIS TN
38138-2588
US

IV. Provider business mailing address

6799 GREAT OAKS RD SUITE 250
MEMPHIS TN
38138-2588
US

V. Phone/Fax

Practice location:
  • Phone: 901-821-8300
  • Fax: 901-261-0701
Mailing address:
  • Phone: 901-821-8300
  • Fax: 901-261-0701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number62798
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: