Provider Demographics
NPI:1437483302
Name:YOAKUM, TANIS A (PA-C)
Entity Type:Individual
Prefix:
First Name:TANIS
Middle Name:A
Last Name:YOAKUM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TANIS
Other - Middle Name:A
Other - Last Name:STUCKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-2450
Mailing Address - Fax:717-851-3469
Practice Address - Street 1:1001 S GEORGE ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3676
Practice Address - Country:US
Practice Address - Phone:717-851-2450
Practice Address - Fax:717-851-3469
Is Sole Proprietor?:No
Enumeration Date:2009-09-25
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054018363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2130919OtherHIGHMARK BLUE SHIELD-WMG
PA1584421OtherGATEWAY-WMG
PAP01242084Medicare PIN