Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0000X | Nurse Practitioner - Neonatal | 108858 | WV |
Y | 363LN0000X | Nurse Practitioner - Neonatal | APRN11013767 | FL |
NPI | 1013597871 |
---|---|
Provider Name | Tara Morder |
First Address | Morgantown, WV 26506-1200 |
Second Address | St Petersburg, FL 33701-4634 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2021 |
Last Update Date | 25/10/2021 |