| NPI | 1215787346 |
|---|---|
| Former Name | TARA BETH LONG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11031965) |
| Enumeration Date | 2024-03-22 |
| Last Update Date | 2024-03-22 |