Provider Demographics
NPI:1578862066
Name:MORAN, TARA GRACE (APRN, DNP)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:GRACE
Last Name:MORAN
Suffix:
Gender:F
Credentials:APRN, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3659 S MIAMI AVE STE 5008
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-4221
Mailing Address - Country:US
Mailing Address - Phone:305-845-0234
Mailing Address - Fax:305-443-4558
Practice Address - Street 1:3659 S MIAMI AVE STE 5008
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4221
Practice Address - Country:US
Practice Address - Phone:305-845-0234
Practice Address - Fax:305-433-4558
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-23
Last Update Date:2024-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9227023363L00000X, 363LA2200X
FLARNP9227023363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty