Provider Demographics
NPI:1912547480
Name:RUDLOFF, TARA COMEAUX (NP)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:COMEAUX
Last Name:RUDLOFF
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 BROCKENBRAUGH CT
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-2710
Mailing Address - Country:US
Mailing Address - Phone:504-606-3064
Mailing Address - Fax:
Practice Address - Street 1:4700 S I 10 SERVICE RD W
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-1269
Practice Address - Country:US
Practice Address - Phone:504-780-4434
Practice Address - Fax:504-780-4316
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAPO5615363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily