Provider Demographics
NPI:1972012342
Name:TENBARGE, CAITLIN ALYSSA (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:ALYSSA
Last Name:TENBARGE
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:13250 HAZEL DELL PKWY STE 104
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-8527
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13250 HAZEL DELL PKWY STE 104
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46033-8527
Practice Address - Country:US
Practice Address - Phone:317-415-6900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-28
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10002324A363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant