Provider Demographics
NPI:1215327853
Name:HEBURN, TARA STRONG (PA-C)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:STRONG
Last Name:HEBURN
Suffix:
Gender:F
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:5432 BEE RIDGE RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-1514
Mailing Address - Country:US
Mailing Address - Phone:941-379-3277
Mailing Address - Fax:941-379-6277
Practice Address - Street 1:2330 UTAH AVE STE 200
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-4817
Practice Address - Country:US
Practice Address - Phone:281-766-0959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-04
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9108554363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical