Provider Demographics
NPI:1619174414
Name:MALHOTRA, TARA (AP)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:MALHOTRA
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 S TAMIAMI TRL
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-4530
Mailing Address - Country:US
Mailing Address - Phone:941-780-7738
Mailing Address - Fax:
Practice Address - Street 1:2700 S TAMIAMI TRL
Practice Address - Street 2:SUITE 3
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-4530
Practice Address - Country:US
Practice Address - Phone:941-780-7738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1740171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAP1740OtherLICENSE