Provider Demographics
NPI:1730598046
Name:GATLIN, TARA
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:GATLIN
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:SURFACE WARFARE MEDICAL INSTITUTE
Mailing Address - Street 2:34101 FARENHOLT AVENUE, BUILDING 14
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92134-5291
Mailing Address - Country:US
Mailing Address - Phone:619-532-7968
Mailing Address - Fax:
Practice Address - Street 1:USS BARRY
Practice Address - Street 2:DDG 52
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09565-1270
Practice Address - Country:US
Practice Address - Phone:757-444-1152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman