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General NPI Number Information
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NPI Number | 1861144511
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Entity Type | Individual
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Provider Name | TARA MARIE PIANKO PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/24/2022
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Last Update Date | 03/09/2022
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Provider Practice Location Address
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Address Line | 6145 SHALLOWFORD RD STE 102
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City | CHATTANOOGA
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State | TN
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Zip | 37421-7808
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Country | US
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Telephone | 423-893-6890
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Fax |
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Provider Business Mailing Address
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Address Line | 6747 PERSIMMON RDG
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City | LOUDON
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State | TN
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Zip | 37774-4773
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Country | US
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Telephone | 303-946-6877
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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 |
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License Number State |
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