Provider Demographics
NPI:1306085907
Name:DEMPSTER, TARA LEIGH (NP)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:LEIGH
Last Name:DEMPSTER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3829 BECKFORD STREET
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-8156
Mailing Address - Country:US
Mailing Address - Phone:843-407-1359
Mailing Address - Fax:843-407-1359
Practice Address - Street 1:3829 BECKFORD ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-8156
Practice Address - Country:US
Practice Address - Phone:843-407-1359
Practice Address - Fax:843-407-1359
Is Sole Proprietor?:No
Enumeration Date:2009-02-05
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13958363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily