Fagan, Tara
Fagan, Tara is an sole proprietor health care provider with primary practice located at 1639 Majestic View Ln , Orange Park FL 32003-3223. She recently has only one registered license in Speech, Language and Hearing Service Providers / Speech-Language Pathologist, which is considered as her primary health care specialty. Fagan, Tara can be contacted via phone (904) 635-4143.Contact Information
Primary practice address
1639 Majestic View Ln
Orange Park FL 32003-3223
Phone: (904) 635-4143
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Speech, Language and Hearing Service Providers / Speech-Language Pathologist | 235Z00000X | SA6601 | Florida |
Profile Details
| NPI number | 1164506192 |
|---|---|
| LBN Legal business name | Fagan, Tara |
| Credentials | SLP |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Oct 25th, 2006 |
| Last updated | May 30th, 2013 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1164506192 | NPPES |
| Florida | MEDICAID | 887580400 |
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