Individual
MS. TARA REXANNE ENNIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1042 MAR WALT DR, FORT WALTON BEACH, FL 32547-6645
(850) 863-0400
(850) 863-0417
Mailing address
1775 LEWIS TURNER BLVD, SUITE 101, FORT WALTON BEACH, FL 32547-1267
(850) 863-0400
(850) 863-0417
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
28214
AL
208600000X
Surgery Physician
Primary
ME121048
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102I028400
M'CARE PROVIDER #
—
05
—
120202
—
AL
Enumeration date
10/26/2006
Last updated
07/07/2021
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us