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General NPI Number Information
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NPI Number | 1013597871
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Entity Type | Individual
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Provider Name | TARA MORDER
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Gender | Female
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Dates
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Enumeration Date | 04/14/2021
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Last Update Date | 10/25/2021
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Provider Practice Location Address
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Address Line | 501 6TH AVE S
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City | ST PETERSBURG
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State | FL
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Zip | 33701-4634
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Country | US
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Telephone | 727-767-4313
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Fax | 727-767-4391
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Provider Business Mailing Address
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Address Line | 1 MEDICAL CENTER DR
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City | MORGANTOWN
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State | WV
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Zip | 26506-1200
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Country | US
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Telephone | 800-988-2273
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LN0000X
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Taxonomy Name | Neonatal Nurse Practitioner
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License Number | 108858
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 363LN0000X
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Taxonomy Name | Neonatal Nurse Practitioner
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License Number | APRN11013767
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License Number State | FL
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