Provider Demographics
NPI:1053973727
Name:TANDARICH, LAUREN CHRISTINE (PA-C)
Entity type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:CHRISTINE
Last Name:TANDARICH
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 1:1160 S PERU ST
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IN
Mailing Address - Zip Code:46034-9601
Mailing Address - Country:US
Mailing Address - Phone:317-984-9311
Mailing Address - Fax:317-984-7302
Practice Address - Street 1:1160 S PERU ST
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IN
Practice Address - Zip Code:46034-9601
Practice Address - Country:US
Practice Address - Phone:317-984-9311
Practice Address - Fax:317-984-7302
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207506146N00000X
PAMA062365363AM0700X, 363AM0700X
PAOA005575363A00000X
IN10003613A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant