Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Carolina Alexandra Van Tulder, PA-C

Individual provider Physician Assistant · NPI 1417433145

Carolina Alexandra Van Tulder, PA-C is a Physician Assistant in Tigard, Oregon. Qualified in 2018, 8 years ago. Practices with Mountain West Derm - Blackhart PLLC, a 103-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Oregon.

Years since qualifying
8
Licensed in
OR
In the registry since
2018
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

10215 SW Hall Blvd
Tigard, OR 97223-8809
Phone: (503) 245-2415
Fax: (503) 244-5963
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 4004 Kruse Way Pl Ste 220, Lake Oswego, OR 97035-2449 — (503) 245-2415

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA214771 (OR)

Record details

NPI number1417433145
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedJuly 16, 2018
Last updated in NPPESApril 15, 2025
Certification dateApril 15, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Group practice Mountain West Derm - Blackhart Pllc — 103 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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