Provider Demographics
NPI:1558868067
Name:DOROSH, TARA ASHLEY (PA-C)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:ASHLEY
Last Name:DOROSH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1610 W CANFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-8457
Mailing Address - Country:US
Mailing Address - Phone:208-420-5606
Mailing Address - Fax:
Practice Address - Street 1:3372 E JENALAN
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-7787
Practice Address - Country:US
Practice Address - Phone:208-262-8700
Practice Address - Fax:208-262-8675
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-1607363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant