Tara Brunson
Individual provider Active NPI Driver · Cordova, TN
NPI 1487407995 · NPPES record last updated Apr 8, 2024
Key facts
- NPI
- 1487407995
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Driver 172A00000X
- License
- 080511698 (TN)
- Practice address
- 1560 Cedar Farms CV
Cordova, TN 38016-6143 - Phone
- (901) 287-0704
- NPI assigned
- Apr 8, 2024
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 080511698 | TN | MD | Driver |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Simply Transportation | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | 080511698 | TN | Yes |
Addresses
Primary practice location
1560 Cedar Farms CV
Cordova, TN 38016-6143
Mailing address
1560 Cedar Farms CV
Cordova, TN 38016-6143
Other providers in Cordova, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 8, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.