Provider Demographics
NPI:1568403368
Name:TROUTT, TAMARA K (PA)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:K
Last Name:TROUTT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:K
Other - Last Name:DUNWIDDIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:470 BENNETT DR
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:IN
Practice Address - Zip Code:46792-9272
Practice Address - Country:US
Practice Address - Phone:260-375-3670
Practice Address - Fax:260-375-3669
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000795A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
INQ49607Medicare PIN
IN234760QMedicare PIN