| NPI | 1255746236 |
|---|---|
| Former Name | TARA BROOKE REYNOLDS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F401669-1) |
| Enumeration Date | 2014-06-27 |
| Last Update Date | 2015-07-30 |