Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Tara Barrack, PA-C

Individual provider Surgical Physician Assistant · NPI 1104266865

Tara Barrack, PA-C is a Physician Assistant in Maple Grove, Minnesota. Qualified in 2013, 13 years ago. Practices with Park Nicollet Clinic, a 1,773-clinician group, works from 3 locations, accepts Medicare assignment and offers telehealth. Licensed in Minnesota.

Years since qualifying
13
Licensed in
MN
In the registry since
2013
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

See every abbreviation used in this directory →

Practice location Address checks out

9555 Upland Ln N
Maple Grove, MN 55369-4485
Phone: (952) 993-1440
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 8100 Northland Dr, Bloomington, MN 55431-4800 — (952) 831-8742
  • 2090 Woodwinds Dr Ste 200, Woodbury, MN 55125-2522 — (651) 968-5201

Specialties & licences

Surgical Physician Assistant (primary) Taxonomy 363AS0400X
Physician Assistant Taxonomy 363A00000X · Licence 11382 (MN)

Record details

NPI number1104266865
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedJune 26, 2013
Last updated in NPPESApril 14, 2020
Certification dateApril 14, 2020
Mailing address9555 Upland Ln N, Maple Grove, MN 55369-4485

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2013 (13 years in practice)
Group practice Park Nicollet Clinic — 1773 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations3 on file with Medicare

Other providers in Maple Grove