MEDICARE: MS. TARA JO DUQUETTE PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA9101236	FL
2	363A00000X	Physician Assistant	PA9101236	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427094994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TARA JO DUQUETTE PA-C

Provider Business Mailing Address
First Line	:	900 VILLAGE SQUARE XING STE 290
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-4552
Country	:	US
Telephone Number	:	239-313-2517
Fax Number	:	239-666-9211

Provider Business Practice Location Address
First Line	:	4002 SUN CITY CENTER BLVD UNIT 102
Second Line	:
City	:	SUN CITY CENTER
State	:	FL
Zip	:	33573-5208
Country	:	US
Telephone Number	:	813-634-1455
Fax Number	:	813-642-8355

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	10/28/2022

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Directions to “ MS. TARA JO DUQUETTE PA-C” Practice Location

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