Provider Demographics
NPI:1841854338
Name:MUSE, TANDY (PA)
Entity type:Individual
Prefix:
First Name:TANDY
Middle Name:
Last Name:MUSE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4460 S HIGHLAND DR STE 400
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-3565
Mailing Address - Country:US
Mailing Address - Phone:801-272-4111
Mailing Address - Fax:801-272-5989
Practice Address - Street 1:4460 S HIGHLAND DR STE 400
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-3565
Practice Address - Country:US
Practice Address - Phone:801-272-4111
Practice Address - Fax:801-272-5989
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
UT11281903-1206207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical