MEDICARE: TARA NICOLE DUNCAN

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	104100000X	Social Worker		FL

General Provider Information

NPI Number	:	1881987402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA NICOLE DUNCAN

Provider Business Mailing Address
First Line	:	7306 MAPLE TREE DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32277-2806
Country	:	US
Telephone Number	:	904-743-8283
Fax Number	:	904-743-0747

Provider Business Practice Location Address
First Line	:	7306 MAPLE TREE DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32277-2806
Country	:	US
Telephone Number	:	904-743-8283
Fax Number	:	904-743-0747

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

Provider Enumeration Date	:	05/17/2011
Last Update Date	:	05/17/2011

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Directions to “ TARA NICOLE DUNCAN ” Practice Location

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