Individual
TARA SOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1836 SOUTH AVE STE 201, LA CROSSE, WI 54601-5429
(608) 782-7300
Mailing address
1836 SOUTH AVE STE 201, LA CROSSE, WI 54601-5429
(608) 782-7300
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA169296
OR
363AS0400X
Surgical Physician Assistant
Primary
7250
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500676956
—
OR
01
—
P01483730
RR MEDICARE (PH&S)
OR
Enumeration date
03/26/2013
Last updated
04/20/2023
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