Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | APRN11002752 | FL |
NPI | 1003585209 |
---|---|
Provider Name | Taryn N Raval |
First Address | Zephyrhills, FL 33542-7505 |
Second Address | Tampa, FL 33606-3658 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2021 |
Last Update Date | 10/09/2021 |