Provider Demographics
NPI:1861144511
Name:PIANKO, TARA MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:MARIE
Last Name:PIANKO
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 1:6747 PERSIMMON RDG
Mailing Address - Street 2:
Mailing Address - City:LOUDON
Mailing Address - State:TN
Mailing Address - Zip Code:37774-4773
Mailing Address - Country:US
Mailing Address - Phone:303-946-6877
Mailing Address - Fax:
Practice Address - Street 1:6145 SHALLOWFORD RD STE 102
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-7808
Practice Address - Country:US
Practice Address - Phone:423-893-6890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-24
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical