Provider Demographics
NPI:1861899213
Name:TAPP, CODY JAY (PA-C)
Entity type:Individual
Prefix:MR
First Name:CODY
Middle Name:JAY
Last Name:TAPP
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:555 E TACHEVAH DR
Mailing Address - Street 2:SUITE 2W-203
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-5750
Mailing Address - Country:US
Mailing Address - Phone:760-323-4272
Mailing Address - Fax:760-323-8597
Practice Address - Street 1:555 E TACHEVAH DR
Practice Address - Street 2:SUITE 2W-203
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-5750
Practice Address - Country:US
Practice Address - Phone:760-323-4272
Practice Address - Fax:760-323-8597
Is Sole Proprietor?:No
Enumeration Date:2014-12-01
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT11496780-1206363AM0700X, 363AS0400X
CA52166363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical