Provider Demographics
NPI:1801952650
Name:HILLS, TARA (LMT)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:HILLS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7395 GULF BLVD
Mailing Address - Street 2:
Mailing Address - City:ST PETE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33706-1955
Mailing Address - Country:US
Mailing Address - Phone:727-363-0772
Mailing Address - Fax:727-363-1703
Practice Address - Street 1:7395 GULF BLVD
Practice Address - Street 2:
Practice Address - City:ST PETE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33706-1955
Practice Address - Country:US
Practice Address - Phone:727-363-0772
Practice Address - Fax:727-363-1703
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA00045175174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist