Provider Demographics
NPI:1497353494
Name:RENTZ, TARCHA (PHD, CFM)
Entity Type:Individual
Prefix:DR
First Name:TARCHA
Middle Name:
Last Name:RENTZ
Suffix:
Gender:F
Credentials:PHD, CFM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6019 NW 90TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653-2990
Mailing Address - Country:US
Mailing Address - Phone:352-358-1651
Mailing Address - Fax:
Practice Address - Street 1:6019 NW 90TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32653-2990
Practice Address - Country:US
Practice Address - Phone:352-358-1651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VACFM03392224900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy Fitter