Provider Demographics
NPI:1952058307
Name:MURPHY, TARA GRACE (PA-S)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:GRACE
Last Name:MURPHY
Suffix:
Gender:F
Credentials:PA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 LEON AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48906-3648
Mailing Address - Country:US
Mailing Address - Phone:517-282-1674
Mailing Address - Fax:
Practice Address - Street 1:2600 LEON AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48906-3648
Practice Address - Country:US
Practice Address - Phone:517-282-1674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-06
Last Update Date:2022-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program