Healthcare Provider Details

I. General information

NPI: 1457834566
Provider Name (Legal Business Name): MR. ZACHARY TARBET
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2018
Last Update Date: 09/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 WILLIAM D TATE AVE
GRAPEVINE TX
76051-3919
US

IV. Provider business mailing address

6112 SPARROW WOOD LN APT 229
FORT WORTH TX
76112-1670
US

V. Phone/Fax

Practice location:
  • Phone: 817-424-9013
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number66086
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: