Provider Demographics
NPI:1093768236
Name:SKINNER, TARA LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:LYNN
Last Name:SKINNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10744
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33757-0744
Mailing Address - Country:US
Mailing Address - Phone:727-532-0002
Mailing Address - Fax:
Practice Address - Street 1:8787 BRYAN DAIRY RD STE 250
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33777-1259
Practice Address - Country:US
Practice Address - Phone:727-391-6296
Practice Address - Fax:813-635-7940
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME61154207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250723400Medicaid
FL080047672OtherRAILROAD MEDICARE
FL080047672OtherRAILROAD MEDICARE
FL250723400Medicaid