Active NPI
Tara Vandenbosch, MS, ATC, CSCS, LAT
- Athletic Trainer
- Miami Shores, FL
National Provider Identifier
1174991210
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AL4125
- Practice address
- 11300 NE 2ND Ave
Miami Shores, FL 33161-6628 - Phone
- (308) 899-3572
- NPI assigned
- Sep 7, 2015
- Last updated
- Sep 7, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | AL4125 | FL | Primary |
Addresses
Primary practice location
11300 NE 2ND Ave
Miami Shores, FL 33161-6628
Mailing address
5725 Garfield St
Hollywood, FL 33021-5150
Phone (860) 912-9745
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AL4125 | FL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1441584000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1441584000000",
"number": "1174991210",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5725 GARFIELD ST",
"city": "HOLLYWOOD",
"state": "FL",
"postal_code": "330215150",
"telephone_number": "860-912-9745"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11300 NE 2ND AVE",
"city": "MIAMI SHORES",
"state": "FL",
"postal_code": "331616628",
"telephone_number": "308-899-3572"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDENBOSCH",
"first_name": "TARA",
"credential": "MS, ATC, CSCS, LAT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-09-07",
"last_updated": "2015-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "FL",
"license": "AL4125",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Miami Shores, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.