Provider Demographics
NPI:1922065770
Name:LOUCKS, TARA CAYE (ARNP)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:CAYE
Last Name:LOUCKS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:PERKINS, PEPPERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 15349
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-5349
Mailing Address - Country:US
Mailing Address - Phone:850-383-3300
Mailing Address - Fax:850-383-3497
Practice Address - Street 1:2140 CENTERVILLE PL
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4342
Practice Address - Country:US
Practice Address - Phone:850-383-3300
Practice Address - Fax:850-383-3497
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 1851312363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q56828Medicare UPIN
U6244ZMedicare ID - Type Unspecified