Individual
TARA IVY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NNP
Contact information
Practice address
6701 FANNIN ST, HOUSTON, TX 77030-2608
(832) 824-1000
Mailing address
2 GREENWAY PLZ STE 300, HOUSTON, TX 77046-0207
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
676984
TX
363LN0000X
Neonatal Nurse Practitioner
Primary
API120342
TX
Other
Enumeration date
09/17/2012
Last updated
02/23/2017
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