Provider Demographics
NPI:1265248314
Name:TARLEY, PROSPER (PA-C)
Entity type:Individual
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First Name:PROSPER
Middle Name:
Last Name:TARLEY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:33117 TURQUOISE LN UNIT 5103
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971-7161
Mailing Address - Country:US
Mailing Address - Phone:267-838-8661
Mailing Address - Fax:
Practice Address - Street 1:12100 BLACK SWAN DR STE 201
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-4991
Practice Address - Country:US
Practice Address - Phone:302-644-3311
Practice Address - Fax:302-644-3300
Is Sole Proprietor?:No
Enumeration Date:2024-12-04
Last Update Date:2024-12-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
DE363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant