Individual
MRS. TATJANA LARISSA ACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
9000 BAILEY COVE RD SE, HUNTSVILLE, AL 35802-4002
(256) 428-4900
(256) 428-4912
Mailing address
PO BOX 2705, HUNTSVILLE, AL 35804-2705
(256) 801-6048
(256) 801-6218
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.501
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
163234
—
AL
01
—
51151377
BCBS
AL
01
—
51151378
BCBS
AL
Enumeration date
11/17/2006
Last updated
01/16/2017
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