Provider Demographics
NPI:1083366223
Name:PANKEY, TARA ANN (AGACNP)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:ANN
Last Name:PANKEY
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 MEDICAL PARK LN STE D
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-4980
Mailing Address - Country:US
Mailing Address - Phone:936-277-1000
Mailing Address - Fax:
Practice Address - Street 1:119 MEDICAL PARK LN STE D
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-4980
Practice Address - Country:US
Practice Address - Phone:936-277-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1066971363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care