Provider Demographics
NPI:1114205531
Name:DESVARIEUX, TAMARA B (NP)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:B
Last Name:DESVARIEUX
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 PEARSALL AVE
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-1542
Mailing Address - Country:US
Mailing Address - Phone:516-778-1736
Mailing Address - Fax:
Practice Address - Street 1:95 PEARSALL AVE
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-1542
Practice Address - Country:US
Practice Address - Phone:516-778-1736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305723363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health