Individual
TARA C VILLANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
47100 COMMUNITY PLZ, STERLING, VA 20164-1826
(703) 880-1403
Mailing address
5000 COX RD, GLEN ALLEN, VA 23060-9263
(804) 965-8700
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110002514
VA
363A00000X
Physician Assistant
PA030369
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005814995
—
VA
01
—
110184642
RAILROAD PALMETTO MEDICARE
DC
Enumeration date
11/04/2005
Last updated
04/06/2022
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