Provider Demographics
NPI:1356818751
Name:NASR, TAREK NAGUIB
Entity Type:Individual
Prefix:
First Name:TAREK
Middle Name:NAGUIB
Last Name:NASR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17132 ROYAL PALM DR
Mailing Address - Street 2:
Mailing Address - City:GROVELAND
Mailing Address - State:FL
Mailing Address - Zip Code:34736-9084
Mailing Address - Country:US
Mailing Address - Phone:352-217-4863
Mailing Address - Fax:
Practice Address - Street 1:10726 LIBBY NUMBER 3 RD
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34715-8734
Practice Address - Country:US
Practice Address - Phone:352-508-5243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-24
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty