Provider Demographics
NPI:1356371611
Name:NORRIS, TARA YOLANDA (PA-C)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:YOLANDA
Last Name:NORRIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 S GLEBE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-2640
Mailing Address - Country:US
Mailing Address - Phone:571-417-7112
Mailing Address - Fax:833-449-3788
Practice Address - Street 1:925 S GLEBE RD STE 101
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-2640
Practice Address - Country:US
Practice Address - Phone:571-417-7112
Practice Address - Fax:833-449-3788
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA0101351363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P90567Medicare UPIN
FLU0761XMedicare ID - Type Unspecified