Provider Demographics
NPI:1003253881
Name:COTTA, TAMARIS SAMANTHA (APRN)
Entity Type:Individual
Prefix:
First Name:TAMARIS
Middle Name:SAMANTHA
Last Name:COTTA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TAMARIS
Other - Middle Name:SAMANTHA
Other - Last Name:GUNAWARDENA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8906 SPANISH RIDGE AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-1319
Mailing Address - Country:US
Mailing Address - Phone:702-330-3102
Mailing Address - Fax:702-912-4994
Practice Address - Street 1:9280 W SUNSET RD STE 400
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-4862
Practice Address - Country:US
Practice Address - Phone:702-366-1268
Practice Address - Fax:702-366-7079
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN002055363L00000X, 363LX0001X
CA23083363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1003253881Medicaid
NVV114668Medicare PIN