Individual
TARA TABBAA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2570 SOM CENTER RD, WILLOUGHBY HILLS, OH 44094-9607
(440) 943-2500
Mailing address
6618 BRETTIN DR, INDEPENDENCE, OH 44131-6541
(216) 789-5753
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
085.007935
IL
363A00000X
Physician Assistant
085-007935
IL
363A00000X
Physician Assistant
Primary
50.006628RX
OH
Other
Enumeration date
11/02/2020
Last updated
11/24/2021
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