Provider Demographics
NPI:1629102538
Name:NOBLE, TARA SHEREE (PA)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:SHEREE
Last Name:NOBLE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 ARCHDALE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-4217
Mailing Address - Country:US
Mailing Address - Phone:704-332-9001
Mailing Address - Fax:
Practice Address - Street 1:500 ARCHDALE DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-4217
Practice Address - Country:US
Practice Address - Phone:704-332-9001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC010-00463363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q79212Medicare UPIN
2768764Medicare PIN