Provider Demographics
NPI:1609077965
Name:SOLH, TIA MARIE (PA)
Entity type:Individual
Prefix:MRS
First Name:TIA
Middle Name:MARIE
Last Name:SOLH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:500 WINDERLEY PL
Mailing Address - Street 2:SUITE 115
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7247
Mailing Address - Country:US
Mailing Address - Phone:313-310-4503
Mailing Address - Fax:
Practice Address - Street 1:500 WINDERLEY PL
Practice Address - Street 2:SUITE 115
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-7247
Practice Address - Country:US
Practice Address - Phone:313-310-4503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004809363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant