Provider Demographics
NPI:1396189171
Name:TARASUIK, JAMES WASSEL JR (FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:WASSEL
Last Name:TARASUIK
Suffix:JR
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:379 HUG CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:IL
Mailing Address - Zip Code:62275-3532
Mailing Address - Country:US
Mailing Address - Phone:618-651-0353
Mailing Address - Fax:
Practice Address - Street 1:379 HUG CEMETERY RD
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:IL
Practice Address - Zip Code:62275-3532
Practice Address - Country:US
Practice Address - Phone:618-651-0353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209010372363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily