MEDICARE: TARA BREAUX NP-C

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	363LA2200X	Adult Health Nurse Practitioner	AP116689	TX

General Provider Information

NPI Number	:	1831366087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA BREAUX NP-C

Provider Business Mailing Address
First Line	:	2875 JIMMY JOHNSON BLVD
Second Line	:	STE 100
City	:	PORT ARTHUR
State	:	TX
Zip	:	77640-2002
Country	:	US
Telephone Number	:	409-729-9222
Fax Number	:	409-722-9425

Provider Business Practice Location Address
First Line	:	610 STRICKLAND DR STE 270
Second Line	:
City	:	ORANGE
State	:	TX
Zip	:	77630-4788
Country	:	US
Telephone Number	:	409-883-5600
Fax Number	:	409-883-3570

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

Provider Enumeration Date	:	05/15/2008
Last Update Date	:	02/10/2016

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