Provider Demographics
NPI:1689661282
Name:HAMILTON, TARA (ARNP)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9305 120TH LN
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-2636
Mailing Address - Country:US
Mailing Address - Phone:727-392-0985
Mailing Address - Fax:
Practice Address - Street 1:3554 1ST AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-8402
Practice Address - Country:US
Practice Address - Phone:727-321-4846
Practice Address - Fax:727-321-3811
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2966472363L00000X
FLARNP2966472363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3053695-00Medicaid
FL3053695-00Medicaid