Tara L Fishback, PA-C
Physician Assistant in Traverse City, Michigan
1528400629- Practice location
- 1221 Sixth St Ste 300, Traverse City, MI 49684-2360
- Phone
- 231-392-0640
- Fax
- 231-392-0643
- Last updated
- July 19, 2021
Tara L Fishback is a Physician Assistant based in Traverse City, MI. Tara L Fishback practices in Traverse City, MI and has the professional credentials of PA-C. The NPI Number for Tara L Fishback is 1528400629 and holds a License No. 5447 (AZ). The current practice location address for Tara L Fishback is 1221 Sixth St Ste 300, Traverse City, MI 49684-2360 and can be reached out via phone at 231-392-0640 and via fax at 231-392-0643.
Provider Profile Details
- NPI Number
- 1528400629
- Provider Name
- Tara L Fishback
- Credential
- PA-C
- Provider Entity Type
- Individual
- Gender
- Female
- Address
- 1221 Sixth St Ste 300, Traverse City, MI 49684-2360
- Phone Number
- 231-392-0640
- Fax Number
- 231-392-0643
- Primary Taxonomy
- Physician Assistant · 363A00000X
- Sole Proprietor
- No
- Other Names
- Tara L Elta, PA-C (Former Name)
- Provider Enumeration Date
- July 18, 2013
- Last Update Date
- July 19, 2021
- Certification Date
- July 19, 2021
- NPI Status
- Active
Provider Business Practice Location Address Details
- Address
- 1221 Sixth St Ste 300
Traverse City, MI 49684-2360 - City
- Traverse City
- State
- Michigan
- Zip
- 49684-2360
- Phone Number
- 231-392-0640
- Fax Number
- 231-392-0643
Provider Business Mailing Address Details
- Address
- 1221 Sixth St Ste 300
Traverse City, MI 49684-2360 - City
- Traverse City
- State
- MI
- Zip
- 49684-2360
- Phone Number
- 231-392-0640
- Fax Number
- 231-392-0643
License Information
- License Number (1)
- 5447
- License State (1)
- AZ
- Taxonomy (1)
- Physician Assistant, Medical · 363AM0700X
- License Number (2)
- 3747-23
- License State (2)
- WI
- Taxonomy (2)
- Physician Assistant, Medical · 363AM0700X
- License Number (3)
- PA1799
- License State (3)
- ME
- Taxonomy (3)
- Physician Assistant, Medical · 363AM0700X
- License Number (4)
- 5601010328
- License State (4)
- MI
- Taxonomy (4)
- Physician Assistant · 363A00000X · Primary
Legacy Identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| No legacy identifiers (Medicaid, Medicare or plan IDs) are on file for this provider. | |||
Other Physician Assistants near Traverse City, MI
View all Physician Assistants in Traverse City →Frequently Asked Questions
What is the NPI number of Tara L Fishback, PA-C?
The NPI number of Tara L Fishback, PA-C is 1528400629. It was assigned on July 18, 2013 and is currently active in the NPPES registry.
What is the specialty of Tara L Fishback, PA-C?
Tara L Fishback, PA-C is registered under the primary taxonomy Physician Assistant (code 363A00000X), licensed in AZ under license number 5447.
Where does Tara L Fishback, PA-C practice?
The practice location is 1221 Sixth St Ste 300, Traverse City, MI 49684-2360. The office can be reached at 231-392-0640 (phone) or 231-392-0643 (fax).
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). It is used in HIPAA standard transactions.
How do I verify this NPI record?
This record is sourced from the public NPPES NPI Registry maintained by CMS. You can confirm it by searching NPI 1528400629 directly on the NPPES registry website.