Provider Demographics
NPI:1568709202
Name:GALLUP, TARA L (CD)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:L
Last Name:GALLUP
Suffix:
Gender:F
Credentials:CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11531 WELLMAN DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-3766
Mailing Address - Country:US
Mailing Address - Phone:813-846-9700
Mailing Address - Fax:
Practice Address - Street 1:11531 WELLMAN DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-3766
Practice Address - Country:US
Practice Address - Phone:813-846-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula