Provider Demographics
NPI:1215569520
Name:GODBY, TARA ELAINE (CPC)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:ELAINE
Last Name:GODBY
Suffix:
Gender:F
Credentials:CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19324 WEARYALL HILL LN
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-4493
Mailing Address - Country:US
Mailing Address - Phone:512-761-4379
Mailing Address - Fax:
Practice Address - Street 1:19324 WEARYALL HILL LN
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-4493
Practice Address - Country:US
Practice Address - Phone:512-761-4379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty