MEDICARE: TARA L BROOKS RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	718218	TX

General Provider Information

NPI Number	:	1013412758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA L BROOKS RN

Provider Business Mailing Address
First Line	:	5119 DENORON DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77048-1601
Country	:	US
Telephone Number	:	713-614-4322
Fax Number	:

Provider Business Practice Location Address
First Line	:	5119 DENORON DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77048-1601
Country	:	US
Telephone Number	:	713-614-4322
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2018
Last Update Date	:	03/26/2018

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