Provider Demographics
NPI:1174519086
Name:BURNS, TARA E (PA)
Entity type:Individual
Prefix:MS
First Name:TARA
Middle Name:E
Last Name:BURNS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6145 W CHANDLER BLVD # 2
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-3434
Mailing Address - Country:US
Mailing Address - Phone:480-454-8744
Mailing Address - Fax:
Practice Address - Street 1:6145 W CHANDLER BLVD # 2
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-3434
Practice Address - Country:US
Practice Address - Phone:480-454-8744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2025-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051911363AS0400X
VA0110004433363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA051911OtherMEDICAL LICENSE