Provider Demographics
NPI:1639059074
Name:SMITH, TARA LEA
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:LEA
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3260 CRUGER AVE APT 2E
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-6435
Mailing Address - Country:US
Mailing Address - Phone:347-737-6397
Mailing Address - Fax:
Practice Address - Street 1:3260 CRUGER AVE APT 2E
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-6435
Practice Address - Country:US
Practice Address - Phone:347-737-6397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula