Individual
DR. TARA T HACKNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
480 W LOWDER ST, MACCLENNY, FL 32063-2664
(904) 259-6291
(904) 259-4761
Mailing address
480 W LOWDER ST, MACCLENNY, FL 32063-2664
(904) 259-6291
(904) 259-4761
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
DN11888
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
071984601
—
FL
Enumeration date
02/28/2006
Last updated
01/23/2013
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