Provider Demographics
NPI:1508866799
Name:SCOTT WHITE, TARA (ARNP)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:SCOTT WHITE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14055 SEAWAY RD
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-4610
Mailing Address - Country:US
Mailing Address - Phone:228-868-5555
Mailing Address - Fax:228-574-2002
Practice Address - Street 1:14055 SEAWAY RD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-4610
Practice Address - Country:US
Practice Address - Phone:228-868-5555
Practice Address - Fax:228-574-2002
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9229816363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306933800Medicaid
FLQ19978Medicare UPIN