| NPI | 1124767793 |
|---|---|
| Former Name | TARYN N DERICKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: FL 11026158) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NE 114182) |
| Enumeration Date | 2022-06-02 |
| Last Update Date | 2023-09-06 |