Provider Demographics
NPI:1699099986
Name:MILLS, TAMARA (PA-C)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:MILLS
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 1:1 HEALTHY PL STE 101
Mailing Address - Street 2:
Mailing Address - City:PATASKALA
Mailing Address - State:OH
Mailing Address - Zip Code:43062-7067
Mailing Address - Country:US
Mailing Address - Phone:220-564-1900
Mailing Address - Fax:220-564-1901
Practice Address - Street 1:1 HEALTHY PL STE 101
Practice Address - Street 2:
Practice Address - City:PATASKALA
Practice Address - State:OH
Practice Address - Zip Code:43062-7067
Practice Address - Country:US
Practice Address - Phone:220-564-1900
Practice Address - Fax:220-564-1901
Is Sole Proprietor?:No
Enumeration Date:2010-03-16
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053948363A00000X
OH003105363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant