Provider Demographics
NPI:1427474774
Name:COCCO, TARA (FNP-C)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:COCCO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 CANTU CT
Mailing Address - Street 2:117
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-6260
Mailing Address - Country:US
Mailing Address - Phone:941-552-8341
Mailing Address - Fax:
Practice Address - Street 1:2201 CANTU CT STE 117
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6254
Practice Address - Country:US
Practice Address - Phone:941-552-8341
Practice Address - Fax:941-487-8025
Is Sole Proprietor?:No
Enumeration Date:2014-03-11
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9183330363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics