Provider Demographics
NPI:1639282841
Name:BATZ, TARA L (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:L
Last Name:BATZ
Suffix:
Gender:F
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 1:711 E ALTAMONTE DR STE 210
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-4824
Mailing Address - Country:US
Mailing Address - Phone:407-303-5452
Mailing Address - Fax:407-303-5448
Practice Address - Street 1:711 E ALTAMONTE DR STE 210
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-4824
Practice Address - Country:US
Practice Address - Phone:407-303-5452
Practice Address - Fax:407-303-5448
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103829363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9103829OtherLICENSE
FLQ72245Medicare UPIN