Provider Demographics
NPI:1497053847
Name:TIGNOR, TARA JEAN (CRNA)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:JEAN
Last Name:TIGNOR
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:JEAN
Other - Last Name:LITTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:520 LAFAYETTE BLVD
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-3723
Mailing Address - Country:US
Mailing Address - Phone:804-441-4782
Mailing Address - Fax:
Practice Address - Street 1:1 TAMPA GENERAL CIR
Practice Address - Street 2:SUITE A327
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3571
Practice Address - Country:US
Practice Address - Phone:813-844-4396
Practice Address - Fax:813-844-4972
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-09
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9313131367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG00PSOtherBCBS
FL003413900Medicaid
FLEV635ZMedicare PIN