Healthcare Provider Details

I. General information

NPI: 1164612941
Provider Name (Legal Business Name): TAMMY JILL FARRELL PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMMY JILL FINSTERBUSCH

II. Dates (important events)

Enumeration Date: 07/27/2007
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E MOUNTAIN BLVD
WILKES BARRE PA
18711-0027
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-4903
US

V. Phone/Fax

Practice location:
  • Phone: 570-808-5447
  • Fax: 570-808-6072
Mailing address:
  • Phone: 570-271-6144
  • Fax: 570-271-6578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA001099L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: