Provider Demographics
NPI:1114798774
Name:CZYZEWSKI, TARAH
Entity type:Individual
Prefix:
First Name:TARAH
Middle Name:
Last Name:CZYZEWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6715 LOCKWOOD RIDGE RD APT 416
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-3698
Mailing Address - Country:US
Mailing Address - Phone:941-724-5426
Mailing Address - Fax:
Practice Address - Street 1:5741 BEE RIDGE RD STE 450
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-5081
Practice Address - Country:US
Practice Address - Phone:941-214-2864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-12
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11030590363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner