Provider Demographics
NPI:1427363712
Name:DELACH, TARA (MA)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:
Last Name:DELACH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5520 W IDLEWILD AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-8015
Mailing Address - Country:US
Mailing Address - Phone:813-901-3439
Mailing Address - Fax:813-882-3689
Practice Address - Street 1:5520 W IDLEWILD AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-8015
Practice Address - Country:US
Practice Address - Phone:813-901-3439
Practice Address - Fax:813-882-3689
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002248900Medicaid