Provider Demographics
NPI:1225292469
Name:POTOKAR, TINA L (MS, PA-C)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:L
Last Name:POTOKAR
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Gender:F
Credentials:MS, PA-C
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Mailing Address - Street 1:PO BOX 8003
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54912-8003
Mailing Address - Country:US
Mailing Address - Phone:920-996-3200
Mailing Address - Fax:920-729-6484
Practice Address - Street 1:1380 TULLAR RD
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-4440
Practice Address - Country:US
Practice Address - Phone:920-727-3480
Practice Address - Fax:920-727-3490
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2021-05-20
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Provider Licenses
StateLicense IDTaxonomies
MN10438363A00000X
WI3418363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant