Provider Demographics
NPI:1396586822
Name:PABIS, TARA JOHNSON (APRN)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:JOHNSON
Last Name:PABIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:SUZANNAH
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4719 HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-7839
Mailing Address - Country:US
Mailing Address - Phone:850-526-3314
Mailing Address - Fax:850-526-5022
Practice Address - Street 1:2870 MONTGOMERY HWY
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-2606
Practice Address - Country:US
Practice Address - Phone:334-500-5500
Practice Address - Fax:334-500-5550
Is Sole Proprietor?:No
Enumeration Date:2024-06-06
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-120710363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily