Provider Demographics
NPI:1952701708
Name:JOSEPH-BLANC, TARA DINKA (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:DINKA
Last Name:JOSEPH-BLANC
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1192 E NEWPORT CENTER DR
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-7753
Mailing Address - Country:US
Mailing Address - Phone:954-571-0124
Mailing Address - Fax:954-571-0105
Practice Address - Street 1:1192 E NEWPORT CENTER DR
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-7753
Practice Address - Country:US
Practice Address - Phone:954-571-0124
Practice Address - Fax:954-571-0105
Is Sole Proprietor?:No
Enumeration Date:2014-08-29
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9240919363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health