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General NPI Number Information
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NPI Number | 1669428132
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Entity Type | Individual
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Provider Name | THERESA ANNE TARQUINIO PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 10/21/2011
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Provider Practice Location Address
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Address Line | 701 NORTHWAY RD
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-3813
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Country | US
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Telephone | 570-322-1637
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Fax | 570-322-1638
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Provider Business Mailing Address
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Address Line | 1201 GRAMPIAN BLVD SUITE 1K
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-1900
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Country | US
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Telephone |
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA003297L
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License Number State | PA
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