Provider Demographics
NPI:1366169823
Name:KIRKLAND, TARA LIANE (APRN)
Entity type:Individual
Prefix:MS
First Name:TARA
Middle Name:LIANE
Last Name:KIRKLAND
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:TARA
Other - Middle Name:LIANE
Other - Last Name:KIRKLAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AGACNP-BC
Mailing Address - Street 1:7236 STONEROCK CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-8000
Mailing Address - Country:US
Mailing Address - Phone:321-841-6444
Mailing Address - Fax:407-650-1307
Practice Address - Street 1:7236 STONEROCK CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8000
Practice Address - Country:US
Practice Address - Phone:321-841-6444
Practice Address - Fax:407-650-1307
Is Sole Proprietor?:No
Enumeration Date:2022-10-25
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11029977363LA2200X
TN32912363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care