MEDICARE: TARA MICHELLE SPILLER MS, RD, LD

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	133V00000X	Registered Dietitian	ND4919	FL

General Provider Information

NPI Number	:	1700077161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA MICHELLE SPILLER MS, RD, LD

Provider Business Mailing Address
First Line	:	2313 E 28TH AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33605-1333
Country	:	US
Telephone Number	:	813-307-8015
Fax Number	:	813-272-5408

Provider Business Practice Location Address
First Line	:	2313 E 28TH AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33605-1333
Country	:	US
Telephone Number	:	813-307-8015
Fax Number	:	813-272-5408

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

Provider Enumeration Date	:	08/09/2007
Last Update Date	:	08/09/2007

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