Provider Demographics
NPI:1669428132
Name:TARQUINIO, THERESA ANNE (PA-C)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:ANNE
Last Name:TARQUINIO
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1201 GRAMPIAN BLVD
Mailing Address - Street 2:SUITE 1K
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-1900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:701 NORTHWAY RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-3813
Practice Address - Country:US
Practice Address - Phone:570-322-1637
Practice Address - Fax:570-322-1638
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2011-10-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMA003297L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP14892Medicare UPIN