Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | AP133439 | TX |
NPI | 1215450887 |
---|---|
Provider Name | Tara L Luzader |
First Address | Fort Worth, TX 76104-7639 |
Second Address | Fort Worth, TX 76104-4917 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2017 |
Last Update Date | 25/07/2017 |