Individual
MRS. TARA LOVETT DETTRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M., C.P.M.
Contact information
Practice address
1093 A1A BEACH BLVD, PMB 285, SAINT AUGUSTINE, FL 32080-6733
(904) 540-7994
(904) 471-4980
Mailing address
1093 A1A BEACH BLVD, PMB 285, SAINT AUGUSTINE, FL 32080-6733
(904) 540-7994
(904) 471-4980
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
MW 227
FL
Other
Enumeration date
04/24/2009
Last updated
04/24/2009
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