Provider Demographics
NPI:1316552714
Name:LARKIN, TARA LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:LEE
Last Name:LARKIN
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 1:1588 SANDY SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-9023
Mailing Address - Country:US
Mailing Address - Phone:904-465-5136
Mailing Address - Fax:
Practice Address - Street 1:1570 ISLAND LN
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-7453
Practice Address - Country:US
Practice Address - Phone:904-303-1404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME138534207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine