| Doctor Name: | MS. TARA MARIE IACONO |
| NPI Number: | 1437308384 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RPA-C |
| License Number: | 6038 |
| Business Practice Address: | 3053 Middle Country Rd Lake Grove, NY - 117552109 |
| Business Phone Number: | 6315885800 |
| Business Fax Number: | |
| Mailing Address: | 14780 W Mountain View Blvd, Ste 110 SURPRISE |
| State: | AZ |
| Postal Code: | 853747280 |
| Phone Number: | 6313875623 |
| Fax Number: | |
| NPI Enumeration Date: | 09/16/2008 |
| NPI Last Update Date: | 03/28/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 193200000X |
| License Number: | 6038 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Group |
| Taxonomy Classification: | Multi-Specialty |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A business group of one or more individual practitioners, who practice with different areas of specialization. |