Provider Demographics
NPI:1861737348
Name:TALLARICO, JILLIAN M (PA-C)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:M
Last Name:TALLARICO
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-721-8795
Mailing Address - Fax:717-336-8284
Practice Address - Street 1:63 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:STEVENS
Practice Address - State:PA
Practice Address - Zip Code:17578-9203
Practice Address - Country:US
Practice Address - Phone:717-721-8795
Practice Address - Fax:717-336-8284
Is Sole Proprietor?:No
Enumeration Date:2012-12-10
Last Update Date:2020-02-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMA055910363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical