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Individual
TARA LAURINE MANLY
Active
Individual
TARA LAURINE MANLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA06458
TX
363AM0700X
Medical Physician Assistant
PA06458
TX
363AS0400X
Surgical Physician Assistant
PA06458
TX
Other
Enumeration date
10/21/2008
Last updated
01/27/2022
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