Individual
TARA BARRACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
9555 UPLAND LN N, MAPLE GROVE, MN 55369-4485
(952) 993-1440
Mailing address
9555 UPLAND LN N, MAPLE GROVE, MN 55369-4485
(952) 993-1440
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
11382
MN
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Enumeration date
06/26/2013
Last updated
04/14/2020
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