Provider Demographics
NPI:1891059432
Name:SILL, TARIN AMY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TARIN
Middle Name:AMY
Last Name:SILL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:TARIN
Other - Middle Name:AMY
Other - Last Name:SILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:202 MEMORIAL DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:EVERETT
Mailing Address - State:PA
Mailing Address - Zip Code:15537-7057
Mailing Address - Country:US
Mailing Address - Phone:814-623-0552
Mailing Address - Fax:814-623-0752
Practice Address - Street 1:202 MEMORIAL DR
Practice Address - Street 2:SUITE 2
Practice Address - City:EVERETT
Practice Address - State:PA
Practice Address - Zip Code:15537-7057
Practice Address - Country:US
Practice Address - Phone:814-623-0552
Practice Address - Fax:814-623-0752
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055577363AM0700X
PAOA003265363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical