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General NPI Number Information
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NPI Number | 1912547480
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Entity Type | Individual
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Provider Name | TARA COMEAUX RUDLOFF NP
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Gender | Female
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Dates
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Enumeration Date | 01/13/2020
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Last Update Date | 01/13/2020
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Provider Practice Location Address
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Address Line | 4700 S I 10 SERVICE RD W
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City | METAIRIE
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State | LA
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Zip | 70001-1269
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Country | US
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Telephone | 504-780-4434
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Fax | 504-780-4316
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Provider Business Mailing Address
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Address Line | 534 BROCKENBRAUGH CT
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City | METAIRIE
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State | LA
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Zip | 70005-2710
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Country | US
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Telephone | 504-606-3064
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APO5615
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License Number State | LA
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