Individual
TARA KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
A.R.N.P.
Contact information
Practice address
3220 S DOUGLAS RD STE B, MIRAMAR, FL 33025-2734
(954) 436-8444
(954) 436-1159
Mailing address
16264 SENECA CIR, DAVIE, FL 33331-2112
(954) 252-9330
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
2170262
FL
Other
Enumeration date
01/29/2007
Last updated
07/08/2007
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