Provider Demographics
NPI:1447947916
Name:WYBERG, TIARA ELIZABETH (PA-C)
Entity type:Individual
Prefix:MRS
First Name:TIARA
Middle Name:ELIZABETH
Last Name:WYBERG
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:TIARA
Other - Middle Name:ELIZABETH
Other - Last Name:JEFFERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3600 FORBES AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-3410
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2000 MEMORIAL DR STE B
Practice Address - Street 2:
Practice Address - City:FARRELL
Practice Address - State:PA
Practice Address - Zip Code:16121-1366
Practice Address - Country:US
Practice Address - Phone:724-777-4071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-24
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant