Provider Demographics
NPI:1073671038
Name:TRIBBLE, TARI LEANNE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TARI
Middle Name:LEANNE
Last Name:TRIBBLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TARI
Other - Middle Name:LEANNE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2101 STONE BLVD #190
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691
Mailing Address - Country:US
Mailing Address - Phone:916-371-4939
Mailing Address - Fax:916-371-4226
Practice Address - Street 1:2101 STONE BLVD #190
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691
Practice Address - Country:US
Practice Address - Phone:916-371-4939
Practice Address - Fax:916-371-4226
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15699363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P70865Medicare UPIN