Provider Demographics
NPI:1124466818
Name:BOMBE, TARA (MA, CF-SLP)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:BOMBE
Suffix:
Gender:F
Credentials:MA, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 W STATE ROAD 434
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-4986
Mailing Address - Country:US
Mailing Address - Phone:407-271-4911
Mailing Address - Fax:407-264-8344
Practice Address - Street 1:1200 W STATE ROAD 434
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4986
Practice Address - Country:US
Practice Address - Phone:407-271-4911
Practice Address - Fax:407-264-8344
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-05
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ6231235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist