Provider Demographics
NPI:1972070472
Name:TARRAU, GRETCHELL MARIA
Entity type:Individual
Prefix:
First Name:GRETCHELL
Middle Name:MARIA
Last Name:TARRAU
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 1:1150 NW 14TH ST STE 609
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-2117
Mailing Address - Country:US
Mailing Address - Phone:305-243-6732
Mailing Address - Fax:
Practice Address - Street 1:1150 NW 14TH ST STE 609
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-2117
Practice Address - Country:US
Practice Address - Phone:305-243-6732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-01
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11000034363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily