MEDICARE: MRS. TARA JILL PRINTZ APRN

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	363LF0000X	Family Nurse Practitioner	APRN11000058	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1952879736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TARA JILL PRINTZ APRN

Provider Business Mailing Address
First Line	:	PO BOX 100 DEPT#394
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38148-0001
Country	:	US
Telephone Number	:	941-300-4440
Fax Number	:	941-404-1760

Provider Business Practice Location Address
First Line	:	4350 FOWLER ST STE 2
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-2600
Country	:	US
Telephone Number	:	239-837-8187
Fax Number	:	855-576-5116

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

Provider Enumeration Date	:	11/09/2018
Last Update Date	:	04/16/2026

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