Individual
MRS. TARA NICOLE DALLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC
Contact information
Practice address
366 NEEDLES TRL, LONGWOOD, FL 32779-4655
(321) 239-2389
Mailing address
366 NEEDLES TRL, LONGWOOD, FL 32779-4655
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
—
—
174H00000X
Health Educator
—
—
174N00000X
Lactation Consultant (Non-RN)
—
—
374J00000X
Doula
Primary
—
—
Other
Enumeration date
01/17/2019
Last updated
01/17/2019
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