Provider Demographics
NPI:1447580840
Name:AUTH, TARA HAGGERTY (MS, PA-C)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:HAGGERTY
Last Name:AUTH
Suffix:
Gender:F
Credentials:MS, PA-C
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Mailing Address - Street 1:9900 BREN ROAD EAST
Mailing Address - Street 2:ATTN--OPERATIONS, MN008-B213
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55343
Mailing Address - Country:US
Mailing Address - Phone:800-561-0861
Mailing Address - Fax:
Practice Address - Street 1:9900 BREN ROAD EAST
Practice Address - Street 2:ATTN--OPERATIONS, MN008-B213
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343
Practice Address - Country:US
Practice Address - Phone:800-561-0861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-06
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT002890363AM0700X
FLPA9114846363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical