Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant |
NPI | 1275007775 |
---|---|
Provider Name | Mrs. Tara Nicole Dalles |
First Address | Longwood, FL 32779-4655 |
Second Address | Longwood, FL 32779-4655 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2019 |
Last Update Date | 17/01/2019 |