TARA REXANNE ENNIS

FORT WALTON BEACH, FL
NPI1700961141
Former NameTARA REXANNE HARDEN
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy208600000X Surgery
(Licence: FL  ME121048)
Additional Taxonomies174400000X Specialist
(Licence: AL  28214)
Enumeration Date2006-10-26
Last Update Date2021-07-07
Business Address
Ms. TARA REXANNE ENNIS MD
1042 MAR WALT DR
FORT WALTON BEACH, FL 32547-6645
Phone number: 850-863-0400
Mailing Address
Ms. TARA REXANNE ENNIS MD
1775 LEWIS TURNER BLVD SUITE 101
FORT WALTON BEACH, FL 32547-1267
Phone number: 850-863-0400