Provider Demographics
NPI:1518275247
Name:TENTINGER, JASON RICHARD (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:RICHARD
Last Name:TENTINGER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3850 MERLE HAY RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-1330
Mailing Address - Country:US
Mailing Address - Phone:515-271-5303
Mailing Address - Fax:
Practice Address - Street 1:3850 MERLE HAY RD
Practice Address - Street 2:SUITE 500
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-1330
Practice Address - Country:US
Practice Address - Phone:515-271-5303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002132363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant