Individual
TRICIA MARIE TAACA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1499 LAKEWOOD DR STE A, MORRIS, IL 60450-1791
(815) 941-5160
(815) 941-5165
Mailing address
415 DEVON LN, BOLINGBROOK, IL 60440-1108
(630) 207-7985
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085.007865
IL
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
04/10/2020
Last updated
08/27/2020
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