Tara Breaux, NP-C
Individual provider Active NPI Adult Health Nurse Practitioner · Orange, TX
NPI 1831366087 · NPPES record last updated Feb 10, 2016
Key facts
- NPI
- 1831366087
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Adult Health Nurse Practitioner 363LA2200X
- License
- AP116689 (TX)
- Practice address
- 610 Strickland Dr Ste 270
Orange, TX 77630-4788 - Phone
- (409) 883-5600
- Fax
- (409) 883-3570
- NPI assigned
- May 15, 2008
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160311000168 | TX | Practitioner - Nurse Practitioner | 5799081105 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AP116689 | TX | MD | Adult Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Stephanie P. Cunningham DO PA | Current |
Accepting new patients | |
| Orange Clinical Associates PA | Past |
Accepting new patients |
Locations
2501 Jimmy Johnson Blvd
Ste 400
Port Arthur, TX 77640
Phone (409) 729-5633
2875 Jimmy Johnson Blvd
Ste 100
Port Arthur, TX 77640
Phone (409) 338-3007
Interoperability endpoints
- tara.breaux.1@21544.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | AP116689 | TX | Yes |
Addresses
Primary practice location
610 Strickland Dr Ste 270
Orange, TX 77630-4788
Mailing address
2875 Jimmy Johnson Blvd
Ste 100
Port Arthur, TX 77640-2002
Phone (409) 729-9222
Other providers in Orange, TX
- Josh Bland
- Nicole Block
- Allisha Gayle Skinner Bonneaux
- Malinda Charisse Boudreaux
- Reatha Jeannette Bradberry I
- Brewer Dental PLLC
- Bright Branch ABA, LLC
- Bright Futures Pediatric Therapy
- Marilee Katherine Brinson
- Darla Brister
All providers in Orange, TX · Adult Health Nurse Practitioner in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 10, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.