Provider Demographics
NPI:1194776153
Name:TARRAS, PAMELA J (ARNP)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:J
Last Name:TARRAS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 WALDEN WOODS CT
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-6953
Mailing Address - Country:US
Mailing Address - Phone:352-256-4103
Mailing Address - Fax:
Practice Address - Street 1:400 S CRAPO ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2997
Practice Address - Country:US
Practice Address - Phone:989-773-5918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9217571363LF0000X
MI4704138423363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL24268Medicare ID - Type UnspecifiedGROUP
FLQ67626Medicare UPIN
FLU7229ZMedicare ID - Type UnspecifiedINDIVIDUAL