Provider Demographics
NPI:1407507064
Name:COOPER, TARA (HEALTH COACH)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:HEALTH COACH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3832 TROPICAL TER
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-3017
Mailing Address - Country:US
Mailing Address - Phone:850-276-0731
Mailing Address - Fax:
Practice Address - Street 1:3832 TROPICAL TER
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3017
Practice Address - Country:US
Practice Address - Phone:850-276-0731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-15
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education