Provider Demographics
NPI:1295122687
Name:EYSTER, JOELLE TANGUY (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JOELLE
Middle Name:TANGUY
Last Name:EYSTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:JOELLE
Other - Middle Name:ERIN
Other - Last Name:TANGUY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:733 GROFF AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17022-2828
Mailing Address - Country:US
Mailing Address - Phone:717-572-0434
Mailing Address - Fax:
Practice Address - Street 1:500 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2391
Practice Address - Country:US
Practice Address - Phone:717-531-6092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0005807363AS0400X, 363A00000X
PAMA060180363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1464027-34Medicaid
MD994LMedicare UPIN