| NPI | 1417316431 |
|---|---|
| Former Name | TARA L. DEACON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110005225) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: VA 0110005225) |
| Enumeration Date | 2016-02-18 |
| Last Update Date | 2023-09-28 |