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Individual

MRS. TARA LEE MADISON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
97 FLAGLER PLAZA DR, PALM COAST, FL 32137-5965
(386) 693-4883
(386) 693-4892
Mailing address
PO BOX 2523, FLAGLER BEACH, FL 32136-2523
(386) 693-4883
(386) 693-4892

Taxonomy

Speciality
Code
Description
License number
State
246Z00000X
Other Specialist/Technologist
Primary
18-44-1424515
FL

Other

Enumeration date
03/11/2014
Last updated
03/11/2014
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