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NPI Code Detail

MEDICARE: MRS. TARA MARIE ICE NNP

MEDICARE: MRS. TARA MARIE ICE NNP
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
1363LN0000XNeonatal Nurse Practitioner11045463FL

General Provider Information

NPI Number : 1356207930
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TARA MARIE ICE NNP
Provider Business Mailing Address
First Line : 1301 CONCORD TER
Second Line :
City : SUNRISE
State : FL
Zip : 33323-2843
Country : US
Telephone Number : 954-692-7615
Fax Number :
Provider Business Practice Location Address
First Line : 3001 W DR MARTIN LUTHER KING JR BLVD
Second Line :
City : TAMPA
State : FL
Zip : 33607-6307
Country : US
Telephone Number : 813-872-2929
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2025
Last Update Date : 05/18/2026

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