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NPI Code Detail

MEDICARE: MRS. TARA DELACH M.A.

MEDICARE: MRS. TARA DELACH M.A.
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
1171M00000XCase Manager/Care Coordinator

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1427363712
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TARA DELACH M.A.
Provider Business Mailing Address
First Line : 5520 W IDLEWILD AVE
Second Line :
City : TAMPA
State : FL
Zip : 33634-8015
Country : US
Telephone Number : 813-901-3439
Fax Number : 813-882-3689
Provider Business Practice Location Address
First Line : 5520 W IDLEWILD AVE
Second Line :
City : TAMPA
State : FL
Zip : 33634-8015
Country : US
Telephone Number : 813-901-3439
Fax Number : 813-882-3689
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2010
Last Update Date : 08/11/2010

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