Provider Demographics
NPI:1891730008
Name:TABAR, TABARE D (PA)
Entity Type:Individual
Prefix:
First Name:TABARE
Middle Name:D
Last Name:TABAR
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4990 GOLDEN GATE PKWY
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34116-6962
Mailing Address - Country:US
Mailing Address - Phone:239-692-8309
Mailing Address - Fax:239-692-8504
Practice Address - Street 1:4990 GOLDEN GATE PKWY
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34116-6962
Practice Address - Country:US
Practice Address - Phone:239-692-8309
Practice Address - Fax:239-692-8504
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA01537363A00000X
FLPA9105645363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant