Provider Demographics
NPI:1710442009
Name:TARJ MEDICAL CENTER
Entity Type:Organization
Organization Name:TARJ MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ARNP
Authorized Official - Prefix:
Authorized Official - First Name:ROSENIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUVERNA
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:954-529-6157
Mailing Address - Street 1:1440 CORAL RIDGE DR STE 287
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-5433
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:175 SOUTH SR 7
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33068
Practice Address - Country:US
Practice Address - Phone:954-586-4349
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care