Provider Demographics
NPI:1235468356
Name:AUGUSTINE, TARA TRINRUD (ARNP)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:TRINRUD
Last Name:AUGUSTINE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:KAY
Other - Last Name:TRINRUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:9100 MLK JR ST N
Mailing Address - Street 2:1107
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-3041
Mailing Address - Country:US
Mailing Address - Phone:727-804-3084
Mailing Address - Fax:
Practice Address - Street 1:4024 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711-1239
Practice Address - Country:US
Practice Address - Phone:727-327-7656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-19
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2887792363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health