Provider Demographics
NPI:1598586943
Name:PEURIFOY, TARA LYNN (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:LYNN
Last Name:PEURIFOY
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16972 LAKEWAY CIR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:TX
Mailing Address - Zip Code:75762-5809
Mailing Address - Country:US
Mailing Address - Phone:903-283-3831
Mailing Address - Fax:
Practice Address - Street 1:501 SAUNDERS AVE STE 320
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-7524
Practice Address - Country:US
Practice Address - Phone:903-606-4300
Practice Address - Fax:903-606-1283
Is Sole Proprietor?:No
Enumeration Date:2024-10-18
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1175479363LA2100X
TX877872363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care