Healthcare Provider Details

I. General information

NPI: 1194776153
Provider Name (Legal Business Name): PAMELA J TARRAS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 09/26/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S CRAPO ST
MOUNT PLEASANT MI
48858-2997
US

IV. Provider business mailing address

2620 WALDEN WOODS CT
MIDLAND MI
48640-6953
US

V. Phone/Fax

Practice location:
  • Phone: 989-773-5918
  • Fax:
Mailing address:
  • Phone: 352-256-4103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9217571
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704138423
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: