1912349879 NPI number — MRS. TARA LYNN LAWS AP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912349879 NPI number — MRS. TARA LYNN LAWS AP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAWS
Provider First Name:
TARA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
AP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LAWS
Provider Other First Name:
TARA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
AP 4641
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1912349879
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/19/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4618 SW 63RD BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAINESVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32608-3880
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-234-8348
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3700 NW 91ST ST STE B300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32606-7352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-234-8348
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/20/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  4641 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4641 . This is a "AP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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