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General NPI Number Information
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NPI Number | 1821965120
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Entity Type | Individual
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Provider Name | TARA OKELOLA
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Gender | Female
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Dates
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Enumeration Date | 10/21/2025
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 6136 FRISCO SQUARE BLVD STE 400
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City | FRISCO
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State | TX
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Zip | 75034-3251
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Country | US
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Telephone | 855-903-7827
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Fax |
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Provider Business Mailing Address
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Address Line | 1021 BRUNI CT
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City | AUBREY
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State | TX
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Zip | 76227-1321
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Country | US
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Telephone |
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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 | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number | 25425781
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License Number State | TX
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