Provider Demographics
NPI:1831682004
Name:HIBBETT, TARA A (PA-C)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:A
Last Name:HIBBETT
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 1:124 W SPRING ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-1534
Mailing Address - Country:US
Mailing Address - Phone:908-386-0910
Mailing Address - Fax:
Practice Address - Street 1:225 WILLIAMSON ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-3625
Practice Address - Country:US
Practice Address - Phone:908-994-5422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant