Provider Demographics
NPI:1407280977
Name:TARBURTON, ALYSSA REX (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:REX
Last Name:TARBURTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:NOELLE
Other - Last Name:REX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3521 SILVERSIDE RD STE 2J
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-4900
Mailing Address - Country:US
Mailing Address - Phone:302-543-5454
Mailing Address - Fax:
Practice Address - Street 1:3521 SILVERSIDE RD STE 2J
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4900
Practice Address - Country:US
Practice Address - Phone:302-543-5454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-02
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC01530363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant