Individual
DR. TARA BETH WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
501 LIVE OAK ST, NEW SMYRNA BEACH, FL 32168-7300
(386) 274-0250
Mailing address
1890 LPGA BLVD STE 250, DAYTONA BEACH, FL 32117-7131
(386) 274-0250
(386) 274-0269
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
31333
OK
208600000X
Surgery Physician
Primary
ME162877
FL
Other
Enumeration date
12/01/2006
Last updated
08/16/2023
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