Basic Information
| Provider Information | |||||||||
| NPI: | 1891958278 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TARRANCE | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | RENEE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 424 SE LANCELOT LN | ||||||||
| Address2: | |||||||||
| City: | LAWTON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 735016392 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5804582134 | ||||||||
| FaxNumber: | 5804582314 | ||||||||
| Practice Location | |||||||||
| Address1: | 3009 NW WILSON ST | ||||||||
| Address2: | |||||||||
| City: | FORT SILL | ||||||||
| State: | OK | ||||||||
| PostalCode: | 735039042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5804582134 | ||||||||
| FaxNumber: | 5804582314 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2008 | ||||||||
| LastUpdateDate: | 07/07/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.