Provider Demographics
NPI:1316796949
Name:TARA PHILCOX LIMITED LIABILITY COMPANY
Entity type:Organization
Organization Name:TARA PHILCOX LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PHILCOX
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:305-560-7583
Mailing Address - Street 1:9079 N DICKENS DR
Mailing Address - Street 2:
Mailing Address - City:CITRUS SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34434-4943
Mailing Address - Country:US
Mailing Address - Phone:727-619-6309
Mailing Address - Fax:352-218-7635
Practice Address - Street 1:9079 N DICKENS DR
Practice Address - Street 2:
Practice Address - City:CITRUS SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34434-4943
Practice Address - Country:US
Practice Address - Phone:727-619-6309
Practice Address - Fax:352-218-7635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty