Individual
MS. TARA SHAJUAN MILES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
545 W BUTLER RD, GREENVILLE, SC 29607-4833
(864) 299-1990
(864) 299-9123
Mailing address
211 BOXWOOD LN, ANDERSON, SC 29621-7300
(864) 221-9352
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
19424
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19424
STATE LICENSE
SC
Enumeration date
04/18/2016
Last updated
05/20/2016
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