Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | ME141216 | FL |
NPI | 1033478698 |
---|---|
Provider Name | Tarah Joy Popp |
First Address | Miramar, FL 33025-3925 |
Second Address | Hollywood, FL 33021-5423 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2012 |
Last Update Date | 15/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103862300 | (05) | FL |