Provider Demographics
NPI:1851320576
Name:TARNASKY, SHERIDAN (PA-C)
Entity Type:Individual
Prefix:
First Name:SHERIDAN
Middle Name:
Last Name:TARNASKY
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:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:HEPPNER
Mailing Address - State:OR
Mailing Address - Zip Code:97836-0009
Mailing Address - Country:US
Mailing Address - Phone:541-676-5504
Mailing Address - Fax:
Practice Address - Street 1:130 THOMPSON AVE.
Practice Address - Street 2:
Practice Address - City:HEPPNER
Practice Address - State:OR
Practice Address - Zip Code:97836
Practice Address - Country:US
Practice Address - Phone:541-676-5504
Practice Address - Fax:541-676-8247
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA00618363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR999897Medicaid
ORP01684Medicare UPIN
OR106549Medicare ID - Type Unspecified