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General NPI Number Information
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NPI Number | 1376689547
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Entity Type | Individual
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Provider Name | TARA KELLY A.R.N.P.
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Gender | Female
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3220 S DOUGLAS RD STE B
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City | MIRAMAR
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State | FL
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Zip | 33025-2734
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Country | US
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Telephone | 954-436-8444
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Fax | 954-436-1159
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Provider Business Mailing Address
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Address Line | 16264 SENECA CIR
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City | DAVIE
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State | FL
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Zip | 33331-2112
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Country | US
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Telephone | 954-252-9330
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 2170262
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License Number State | FL
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