Provider Demographics
NPI:1639611908
Name:STINE, TARA
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:STINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 214
Mailing Address - Street 2:
Mailing Address - City:SPINNERSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18968
Mailing Address - Country:US
Mailing Address - Phone:215-536-1848
Mailing Address - Fax:
Practice Address - Street 1:2410 HIETER ROAD
Practice Address - Street 2:
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951
Practice Address - Country:US
Practice Address - Phone:215-536-1848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-17
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program