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1083871693
TARA SHANNON CONDREY
JACKSONVILLE, FL
NPI
1083871693
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Other Name
TARA WALL
Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: FL PA9104580)
Enumeration Date
2008-05-21
Last Update Date
2015-03-13
Business Address
-- TARA SHANNON CONDREY PA
11512 LAKE MEAD AVE SUITE 531
JACKSONVILLE, FL 32256-9680
Phone number: 904-419-2054
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Mailing Address
-- TARA SHANNON CONDREY PA
11512 LAKE MEAD AVE SUITE 531
JACKSONVILLE, FL 32256-9680
Phone number: 904-419-2054
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