Provider Demographics
NPI:1952879736
Name:PRINTZ, TARA JILL (APRN)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:JILL
Last Name:PRINTZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:TARA
Other - Middle Name:JILL
Other - Last Name:HEROUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 100 DEPT#394
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:941-300-4440
Mailing Address - Fax:941-404-1760
Practice Address - Street 1:1224 DEL PRADO BLVD S STE A
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3670
Practice Address - Country:US
Practice Address - Phone:239-945-9401
Practice Address - Fax:877-370-2835
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-09
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11000058363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily