Provider Demographics
NPI:1528886991
Name:COOK, TACARA RANADA LEE
Entity type:Individual
Prefix:
First Name:TACARA
Middle Name:RANADA LEE
Last Name:COOK
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 1:7020 CARMEL ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-5202
Mailing Address - Country:US
Mailing Address - Phone:803-915-0609
Mailing Address - Fax:
Practice Address - Street 1:9370 WINDSOR LAKE BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-1995
Practice Address - Country:US
Practice Address - Phone:803-699-1121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care