Provider Demographics
NPI:1861911661
Name:TARICSKA, JULIE EMMA (PA-C)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:EMMA
Last Name:TARICSKA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:26 PRESUMPSCOT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-5102
Mailing Address - Country:US
Mailing Address - Phone:239-682-6994
Mailing Address - Fax:
Practice Address - Street 1:100 FODEN ROAD
Practice Address - Street 2:WEST BUILDING, SUITE 103
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106
Practice Address - Country:US
Practice Address - Phone:207-828-1122
Practice Address - Fax:207-828-0188
Is Sole Proprietor?:No
Enumeration Date:2017-09-12
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA1729363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant