1952879736 NPI number — MRS. TARA JILL PRINTZ APRN

Table of content: MRS. TARA JILL PRINTZ APRN (NPI 1952879736)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952879736 NPI number — MRS. TARA JILL PRINTZ APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRINTZ
Provider First Name:
TARA
Provider Middle Name:
JILL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HEROUX
Provider Other First Name:
TARA
Provider Other Middle Name:
JILL
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1952879736
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1224 DEL PRADO BLVD S STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAPE CORAL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33990-3670
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-945-9401
Provider Business Practice Location Address Fax Number:
877-370-2835
Provider Enumeration Date:
11/09/2018

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: 363LF0000X , with the licence number:  APRN11000058 , 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)