Fishback, Tara L
Fishback, Tara L is an individual health care provider with primary practice located at 1221 Sixth St Ste 300 , Traverse City MI 49684-2360. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Medical, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is her primary health care specialty. Fishback, Tara L can be contacted via phone (231) 392-0640.Contact Information
Primary practice address
1221 Sixth St Ste 300
Traverse City MI 49684-2360
Phone: (231) 392-0640
Fax: (231) 392-0643
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | 5447 | Arizona |
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | 3747-23 | Wisconsin |
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | PA1799 | Maine |
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | 5601010328 | Michigan |
Profile Details
| NPI number | 1528400629 |
|---|---|
| LBN Legal business name | Fishback, Tara L |
| Credentials | Physician's Assistant Certified (PA-C) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 18th, 2013 |
| Last updated | Jul 19th, 2021 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1528400629 | NPPES |
| Arizona | MEDICAID | 832909 |
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