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General NPI Number Information
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NPI Number | 1013279348
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Entity Type | Individual
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Provider Name | TARA JANSE PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/12/2012
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Last Update Date | 11/10/2025
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Provider Practice Location Address
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Address Line | 18275 N 59TH AVE STE K162
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City | GLENDALE
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State | AZ
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Zip | 85308-1260
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Country | US
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Telephone | 602-755-0800
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Fax | 602-560-2721
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Provider Business Mailing Address
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Address Line | PO BOX 24981
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City | BELFAST
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State | ME
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Zip | 04915-2000
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Country | US
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Telephone | 844-969-0686
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Fax | 773-832-7083
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 7647
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License Number State | AZ
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