TARA MARIE OTTO (NPI# 1356509038) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356509038 |
| Entity Type | Individual |
| Full Name | TARA MARIE OTTO |
| Other Name | TARA MARIE BRENTS |
| Credential | MD |
| Practice Address |
220 Fliva Ave Nw Fort Walton Beach FL 32548 |
| Mailing Address |
11995 Singletree Ln Ste 500 Eden Prairie MN 55344-5347 |
| Practice Telephone | 9525951100 |
| Practice Fax Number | 6122944903 |
| Mailing Telephone | 9525951301 |
| Mailing Fax Number | 6122944903 |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2018-06-21 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
ME113202 | FL | Allopathic & Osteopathic Physicians |
| Street Address |
220 FLIVA AVE NW |
| City | FORT WALTON BEACH |
| State | FL |
| Zip Code | 32548 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932718426 | Erica Darby | Pharmacist | Publix, 421 Mary Esther Cut Off, Fort Walton Beach, FL 32548 | 2020-07-30 |
| 1770136681 | Michael Cody Jones | Pharmacist | 251 Miacle Strip Pkwy Se, Fort Walton Beach, FL 32548 | 2019-07-19 |
| 1346714532 | Alison Ann Gould | Occupational Therapy Assistant | Emerald Coast Heath Care, 114 Third St, Fort Walton Beach, FL 32548 | 2019-01-22 |
| 1699217695 | Mayra Lopez | Dentist | Blvd. Gomez Morin #8569, Suite 6a, Juarez, CHIHUAHUA 32548 | 2016-11-08 |
| 1265808455 | Rajiv Tuladhar Dmd Holdings, Pllc | Dentist | 516 Mary Esther Blvd Ste 2, Fort Walton Beach, FL 32548 | 2015-08-11 |
| 1881090702 | Annette Peadro | Behavioral Analyst | 171 Brooks St, Suite 308, Fort Walton Beach, FL 32548 | 2014-11-05 |
| 1790037729 | Julie Bradfield | Counselor | 44 Shell Ave, Fort Walton Beach, FL 32548 | 2012-10-15 |
| 1740559582 | Beth Paula Ritenour | Pharmacist | 414 Mary Esther Cutoff Nw, C, Fort Walton Beach, FL 32548 | 2011-12-23 |
| 1891080867 | Okaloosa County Council On Aging | Home Health | 207 Hospital Drive, Fort Walton Beach, FL 32548 | 2011-06-17 |
| 1649580275 | Sharon Renee Wise | Counselor | 44 Shell Avenue Se, Fort Walton Beach, FL 32548 | 2010-10-17 |
| Find all providers in zip 32548 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356983829 | North Florida Radiology Associates Pllc | Radiology | 1992 Lewis Turner Blvd, Fort Walton Beach, FL 32547-1255 | 2019-10-16 |
| 1356309074 | Florida Diagnostic Imaging Center | Radiology | 908 Mar Walt Dr, Fort Walton Beach, FL 32547-6706 | 2006-05-02 |
| 1285628743 | Vincent Thomas Jones | Radiology | 1005 Mar Walt Drive, Radiology Department, Fort Walton Beach, FL 32547-6796 | 2005-09-09 |
| 1710522602 | Fort Walton Open Radiology, Pllc | Radiology | 908 Mar Walt Dr, Fort Walton Beach, FL 32547-6706 | 2019-11-14 |
| 1831595792 | Dolphin Radiology Pllc | Radiology | 908 Mar Walt Dr, Fort Walton Beach, FL 32547-6706 | 2014-11-05 |
| 1750524393 | Coastal Radiology Associates Pa | Radiology | 1000 Mar Walt Dr, Fort Walton Beach, FL 32547-6708 | 2009-04-13 |
| 1669555967 | Florida Diagnostic Imaging Center | Radiology | 908 Mar Walt Dr, Fort Walton Beach, FL 32547-6706 | 2006-10-23 |
| 1487626164 | Walter William Perrott | Radiology | 1000 Mar Walt Dr, Fort Walton Beach, FL 32547-6708 | 2006-02-06 |
| 1164493235 | Bethany A Cazenave | Radiology | 1000 Mar Walt Dr, Fort Walton Beach, FL 32547-6708 | 2006-01-27 |
| 1861463937 | Craig R Cazenave | Radiology | 1000 Mar Walt Dr, Fort Walton Beach, FL 32547-6708 | 2006-01-27 |
| Find all providers in FORT WALTON BEACH | ||||
| City | FORT WALTON BEACH |
| Zip Code | 32548 |
Please comment or provide details below to improve the information on TARA MARIE OTTO.
| 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.