Provider Demographics
NPI:1922346535
Name:MARBREY, TARA LYNN
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:LYNN
Last Name:MARBREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3185 STATE ROUTE 200
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TN
Mailing Address - Zip Code:38340-7244
Mailing Address - Country:US
Mailing Address - Phone:731-435-9079
Mailing Address - Fax:800-343-1761
Practice Address - Street 1:3185 STATE ROUTE 200
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TN
Practice Address - Zip Code:38340-7244
Practice Address - Country:US
Practice Address - Phone:731-435-9079
Practice Address - Fax:800-343-1761
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0005168171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor