Provider Demographics
NPI:1093073926
Name:GRATTIC, TARYN MICHELLE (PA)
Entity Type:Individual
Prefix:
First Name:TARYN
Middle Name:MICHELLE
Last Name:GRATTIC
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 1387
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-1387
Mailing Address - Country:US
Mailing Address - Phone:208-415-0299
Mailing Address - Fax:208-625-2070
Practice Address - Street 1:925 E POLSTON AVE
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-9049
Practice Address - Country:US
Practice Address - Phone:208-618-0787
Practice Address - Fax:844-807-3782
Is Sole Proprietor?:No
Enumeration Date:2012-04-28
Last Update Date:2021-08-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IDPA-982363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant