Individual
DANIELLE M. TABAKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
11 ARKONA DR, HIGGANUM, CT 06441-4479
(860) 554-5021
Mailing address
11 ARKONA DR, HIGGANUM, CT 06441-4479
(860) 554-5021
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
001698
CT
363AM0700X
Medical Physician Assistant
Primary
001698
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1698
CT LICENSE
CT
Enumeration date
08/24/2005
Last updated
07/07/2014
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