Provider Demographics
NPI:1043289630
Name:COBB, TARA ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:ANN
Last Name:COBB
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1050 SE MONTEREY RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-4512
Mailing Address - Country:US
Mailing Address - Phone:772-288-2400
Mailing Address - Fax:772-419-0144
Practice Address - Street 1:1050 SE MONTEREY RD
Practice Address - Street 2:SUITE 400
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4512
Practice Address - Country:US
Practice Address - Phone:772-288-2400
Practice Address - Fax:772-419-0144
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2018-11-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9101659363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP44928Medicare UPIN
FLE6550ZMedicare ID - Type Unspecified