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General NPI Number Information
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NPI Number | 1124629902
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Entity Type | Individual
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Provider Name | TARA-KAYE CLUNIS APRN
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Gender | Female
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Dates
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Enumeration Date | 11/06/2020
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Last Update Date | 01/04/2023
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Provider Practice Location Address
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Address Line | 1600 S ANDREWS AVE
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316-2510
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Country | US
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Telephone | 954-527-3782
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Fax |
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Provider Business Mailing Address
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Address Line | 832 NW 130TH AVE
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City | PEMBROKE PINES
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State | FL
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Zip | 33028-3135
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Country | US
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Telephone | 954-292-7574
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 11010290
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 11010290
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License Number State | FL
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