Provider Demographics
NPI:1962888248
Name:TARQUINI, KIRSTIN A
Entity type:Individual
Prefix:
First Name:KIRSTIN
Middle Name:A
Last Name:TARQUINI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 W SCHUYLKILL RD STE G15A
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19465-7438
Mailing Address - Country:US
Mailing Address - Phone:610-326-9460
Mailing Address - Fax:610-222-5006
Practice Address - Street 1:351 W SCHUYLKILL RD STE G15A
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19465-7438
Practice Address - Country:US
Practice Address - Phone:610-326-9460
Practice Address - Fax:610-222-5006
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019651363AM0700X
PAMA057236363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400155497Medicare PIN