Healthcare Provider Details

I. General information

NPI: 1770340077
Provider Name (Legal Business Name): SHEILA M TARWATER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHEILA M GOINS

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 S LIMESTONE ST
SPRINGFIELD OH
45505-1965
US

IV. Provider business mailing address

651 S LIMESTONE ST
SPRINGFIELD OH
45505-1965
US

V. Phone/Fax

Practice location:
  • Phone: 937-324-1111
  • Fax: 937-525-4543
Mailing address:
  • Phone: 937-324-1111
  • Fax: 937-525-4542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.008909RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: