# TIARA F PACKER

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1447313010
- **Gender:** F
- **Credential:** PA-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363AS0400X | Surgical Physician Assistant | 0614 | NH | — |
| 363AS0400X | Surgical Physician Assistant | PA130018 | OR | Yes |

## Other

- **Enumeration date:** 12/18/2006
- **Last updated:** 09/24/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 01Y005045NH02 | ANTHEM BCBS MCH | NH |
| 01 | — | 01Y005045NH03 | ANTHEM BCBS MOA | NH |
| 05 | — | 30334821 | — | NH |