Provider Demographics
NPI:1821022153
Name:TALLBACKA, RACHEL BEVERLY (PA)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:BEVERLY
Last Name:TALLBACKA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:SAYLOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:206 W ROCKWELL AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-7439
Mailing Address - Country:US
Mailing Address - Phone:907-262-7566
Mailing Address - Fax:907-262-0809
Practice Address - Street 1:13945 N US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-8924
Practice Address - Country:US
Practice Address - Phone:352-277-3500
Practice Address - Fax:352-277-3498
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA1905363AM0700X
AK2348363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical