Provider Demographics
NPI:1316767650
Name:SCHUELLER, TARA MEGAN (PA-C)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:MEGAN
Last Name:SCHUELLER
Suffix:
Gender:
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 1:3434 MIDWAY DR STE 2001
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-4924
Mailing Address - Country:US
Mailing Address - Phone:619-325-1161
Mailing Address - Fax:
Practice Address - Street 1:3434 MIDWAY DR STE 2001
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-4924
Practice Address - Country:US
Practice Address - Phone:619-325-1161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-11
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA65989363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant