Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 777138 | TX |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | ARNP9218537 | FL |
NPI | 1144453291 |
---|---|
Provider Name | Ms. Tara Beth Gant |
First Address | Dallas, TX 75204-1588 |
Second Address | Dallas, TX 75235-7701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2009 |
Last Update Date | 27/11/2018 |