Healthcare Provider Details

I. General information

NPI: 1285191841
Provider Name (Legal Business Name): SARAH A TAZA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2019
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7250 CLEARVISTA DR STE 355
INDIANAPOLIS IN
46256-5609
US

IV. Provider business mailing address

6626 E 75TH ST STE 500
INDIANAPOLIS IN
46250-2890
US

V. Phone/Fax

Practice location:
  • Phone: 317-621-5676
  • Fax:
Mailing address:
  • Phone: 317-621-7588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10002671A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: