Healthcare Provider Details

I. General information

NPI: 1427094994
Provider Name (Legal Business Name): TARA JO DUQUETTE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 10/28/2022
Certification Date: 10/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4002 SUN CITY CENTER BLVD UNIT 102
SUN CITY CENTER FL
33573-5208
US

IV. Provider business mailing address

900 VILLAGE SQUARE XING STE 290
PALM BEACH GARDENS FL
33410-4552
US

V. Phone/Fax

Practice location:
  • Phone: 813-634-1455
  • Fax: 813-642-8355
Mailing address:
  • Phone: 239-313-2517
  • Fax: 239-666-9211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9101236
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9101236
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: