Provider Demographics
NPI:1740771955
Name:GEORGE, TARA TOMY (PA-C)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:TOMY
Last Name:GEORGE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:TOMY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:3000 MEDICAL PARK DR STE 500
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-6600
Mailing Address - Country:US
Mailing Address - Phone:813-615-7028
Mailing Address - Fax:813-615-8008
Practice Address - Street 1:3000 MEDICAL PARK DR STE 500
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-6600
Practice Address - Country:US
Practice Address - Phone:813-615-7028
Practice Address - Fax:813-615-8008
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9111145363AM0700X
PAMA064365363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical