Individual
MS. TARA MARIE DISALLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1691 W HORIZON RIDGE PKWY, SUITE 100, HENDERSON, NV 89012-3520
(702) 804-1212
(702) 804-1222
Mailing address
1691 W HORIZON RIDGE PKWY, SUITE 100, HENDERSON, NV 89012-3520
(702) 804-1212
(702) 804-1222
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
50.005132RX
OH
363A00000X
Physician Assistant
50.005132RX
OH
363A00000X
Physician Assistant
Primary
PA2405
NV
Other
Enumeration date
08/01/2017
Last updated
04/12/2021
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