Provider Demographics
NPI:1700988235
Name:TAR, KAREN HOWELL (MSN, JD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:HOWELL
Last Name:TAR
Suffix:
Gender:F
Credentials:MSN, JD
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:HOWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSN, CRNP, JD
Mailing Address - Street 1:22226 WESTCHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-9202
Mailing Address - Country:US
Mailing Address - Phone:941-625-3402
Mailing Address - Fax:941-870-9195
Practice Address - Street 1:22226 WESTCHESTER BLVD
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-9202
Practice Address - Country:US
Practice Address - Phone:941-625-3402
Practice Address - Fax:941-870-9195
Is Sole Proprietor?:No
Enumeration Date:2006-09-04
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP-00131-H363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA529752OtherBLUE SHIELD
PA07395174Medicaid
PA07395174Medicaid