Provider Demographics
NPI:1609587401
Name:TOLBERT, TARA DENISE (CNA)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:DENISE
Last Name:TOLBERT
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 7TH CT
Mailing Address - Street 2:
Mailing Address - City:CLEWISTON
Mailing Address - State:FL
Mailing Address - Zip Code:33440-5518
Mailing Address - Country:US
Mailing Address - Phone:904-303-7629
Mailing Address - Fax:
Practice Address - Street 1:2403 7TH CT
Practice Address - Street 2:
Practice Address - City:CLEWISTON
Practice Address - State:FL
Practice Address - Zip Code:33440-5518
Practice Address - Country:US
Practice Address - Phone:904-303-7629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA414566376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide