Provider Demographics
NPI:1952731671
Name:TARVER, QUEEN (RN)
Entity Type:Individual
Prefix:
First Name:QUEEN
Middle Name:
Last Name:TARVER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 TOWHEE RD
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-8250
Mailing Address - Country:US
Mailing Address - Phone:863-514-7974
Mailing Address - Fax:
Practice Address - Street 1:335 TOWHEE RD
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-8250
Practice Address - Country:US
Practice Address - Phone:863-514-7974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-15
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9372197163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse