DR. TARA D WILSON (NPI# 1194899740) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194899740 |
| Entity Type | Individual |
| Full Name | DR. TARA D WILSON |
| Credential | MD |
| Practice Address |
303 N Clyde Morris Blvd Daytona Beach FL 32114-2709 |
| Practice Telephone | 3862542285 |
| Practice Fax Number | 3864251304 |
| Mailing Telephone | 3862542285 |
| Mailing Fax Number | 3864251304 |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2016-06-13 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207P00000X | Emergency Medicine | ME081444 | FL | Allopathic & Osteopathic Physicians |
| Y | 207Q00000X | Family Medicine | ME81444 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | STATE MEDICAL LICENSE | ME81444 | 01 |
| FL | 264005800 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174006035 | Tara Nicole Wilson | Physician Assistant | 110 Irving Sreet Nw, Room 4b-42, Washington, DC 20010-2975 | 2018-09-07 |
| 1740640762 | Tara Starr Wilson | Licensed Practical Nurse | 3011 Ferguson Rd, 2, Cincinnati, OH 45238-2430 | 2016-03-03 |
| 1558700336 | Tara Ann Wilson | Counselor | 309 West 3, Rushville, NE 69360-0779 | 2013-06-14 |
| 1487292249 | Tara Frances Wilson | Student in an Organized Health Care Education/Training Program | 3600 Route 112, Coram, NY 11727-4116 | 2019-12-11 |
| 1003134347 | Tara Jene Wilson | Specialist/Technologist, Other | 9800 Centre Pkwy, 530, Houston, TX 77036-8271 | 2010-05-11 |
| 1033446877 | Tara Marie Wilson | Case Manager/Care Coordinator | 7777 E Us Highway 66, El Reno, OK 73036-9125 | 2009-11-16 |
| 1386886620 | Tara M Wilson | Specialist/Technologist, Other | 13430 N Meridian St, Suite 275, Carmel, IN 46032-1405 | 2009-04-01 |
| 1811159106 | Tara Sansone Wilson | Physical Medicine & Rehabilitation | 11539 Park Woods Cir, Suite 502, Alpharetta, GA 30005-4413 | 2008-06-27 |
| 1922176429 | Tara Beth Wilson | Surgery | 1809 E 13th St, Suite 400, Tulsa, OK 74104-4419 | 2006-12-01 |
| 1083790323 | Tara L Wilson | Dentist | 5710 Whitmore Lake Rd, Brighton, MI 48116-1902 | 2006-10-30 |
| Street Address |
303 N CLYDE MORRIS BLVD |
| City | DAYTONA BEACH |
| State | FL |
| Zip Code | 32114-2709 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811991227 | Halifax Hospital Medical Center | Case Management | 303 N Clyde Morris Blvd, Daytona Beach, FL 32114-2709 | 2005-06-13 |
| 1447860374 | Priscilla Selig | Nurse Practitioner | 303 N Clyde Morris Blvd, Daytona Beach, FL 32114-2709 | 2020-08-05 |
| 1770123820 | Jane Hollis | Nurse Practitioner | 303 N Clyde Morris Blvd, Daytona Beach, FL 32114-2709 | 2020-01-07 |
| 1619512282 | Kristin Patrice Gardner | Nurse Practitioner | 303 N Clyde Morris Blvd, Daytona Beach, FL 32114-2709 | 2019-11-07 |
| 1447804364 | Brenda Martin Cohen | Nurse Practitioner | 303 N Clyde Morris Blvd, Daytona Beach, FL 32114-2709 | 2019-07-29 |
| 1285296574 | Cassie C Norris | Nurse Practitioner | 303 N Clyde Morris Blvd, Daytona Beach, FL 32114-2709 | 2019-07-08 |
| 1063077667 | Jara Apperley | Physician Assistant | 303 N Clyde Morris Blvd, Daytona Beach, FL 32114-2709 | 2019-05-08 |
| 1972068153 | Sreyboth Sreng | Nurse Practitioner | 303 N Clyde Morris Blvd, Daytona Beach, FL 32114-2709 | 2019-02-01 |
| 1356811244 | Matthew Evans | Nurse Anesthetist, Certified Registered | 303 N Clyde Morris Blvd, Daytona Beach, FL 32114-2709 | 2018-12-04 |
| 1932679503 | Amanda Gonzalez | Nurse Anesthetist, Certified Registered | 303 N Clyde Morris Blvd, Daytona Beach, FL 32114 | 2018-11-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376161380 | Evolution Health & Performance LLC | Physician Assistant | 244 S. Palmetto Ave, Daytona Beach, FL 32114 | 2020-07-07 |
| 1407480189 | Kierra Imani Kinsey | Behavior Technician | 1128-a Beville Rd, Daytona Beach, FL 32114 | 2020-03-02 |
| 1043776057 | Outreach Community Care Network Inc | Pharmacy | 240 N. Frederick Avenue, Daytona Beach, FL 32114 | 2019-02-14 |
| 1033681861 | Katherine Proppe | Specialist/Technologist | 1 Aerospace Blvd, Daytona Beach, FL 32114 | 2018-12-18 |
| 1841765047 | Anna L Smith | Nurse Practitioner | 339 Bill France Blvd Ste C, Daytona Beach, FL 32114 | 2018-10-04 |
| 1154806933 | Steve Anthony Lee | Family Medicine | 731 N. Clyde Morris Blvd, Daytona Beach, FL 32114 | 2018-09-27 |
| 1285116491 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 1348 W International Speedway Blvd Ste 2, Daytona Beach, FL 32114 | 2018-09-04 |
| 1770085656 | Merina Lee | Occupational Therapist | 1159 Australia Ave., Daytona Beach, FL 32114 | 2018-03-06 |
| 1346752755 | Hand & Upper Extremity Surgery of Daytona Beach, LLC | Non-Pharmacy Dispensing Site | 1241 Ridgewood Ave, Daytona Beach, FL 32114 | 2017-10-26 |
| 1104347053 | Harry Herman Blanke IIi | Family Medicine | 201 N Clyde Morris Blvd, Suite 200, Halifax Health Family Medicine Residency Program, Daytona Beach, FL 32114 | 2017-06-30 |
| Find all providers in zip 32114 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164063178 | Jordann Wood | Family Medicine | 1890 Lpga Blvd Ste 140, Daytona Beach, FL 32117-7131 | 2019-10-01 |
| 1154806933 | Steve Anthony Lee | Family Medicine | 731 N. Clyde Morris Blvd, Daytona Beach, FL 32114 | 2018-09-27 |
| 1104347053 | Harry Herman Blanke IIi | Family Medicine | 201 N Clyde Morris Blvd, Suite 200, Halifax Health Family Medicine Residency Program, Daytona Beach, FL 32114 | 2017-06-30 |
| 1245636042 | Dr Ejaz Ahmed Md Pa | Family Medicine | 405 North Clyde Morris Blvd, Daytona Beach, FL 32114-2730 | 2014-11-06 |
| 1063703833 | Brittany O'dwyer Newton | Family Medicine | 201 N Clyde Morris Blvd Ste 210, Daytona Beach, FL 32114-2765 | 2011-04-27 |
| 1548498561 | Ayodeji Ladele | Family Medicine | 1410 Lpga Blvd Ste 136, Daytona Beach, FL 32117-5146 | 2009-06-29 |
| 1417182932 | Phillip Michael Mele Jr. | Family Medicine | 331 Williams Ave, Daytona Beach, FL 32118-3339 | 2009-05-28 |
| 1326280991 | Kevin Anthony Johnson | Family Medicine | 1400 Hancock Blvd, #1208, Daytona Beach, FL 32114 | 2009-03-29 |
| 1265658744 | Jessika Gil-pineda | Family Medicine | 1300 Red John Dr, Daytona Beach, FL 32124-1075 | 2007-04-17 |
| 1548381049 | Andrew Jonathan Niewald | Family Medicine | 305 Memorial Medical Pkwy Ste 502, Daytona Beach, FL 32117-5169 | 2007-04-02 |
| Find all providers in DAYTONA BEACH | ||||
| City | DAYTONA BEACH |
| Zip Code | 32114 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.