Provider Demographics
NPI:1154096501
Name:NELSON, TAMARA JUEL (CNM, RN)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:JUEL
Last Name:NELSON
Suffix:
Gender:F
Credentials:CNM, RN
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:JUEL
Other - Last Name:BRAUND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1505 SOQUEL DR STE 1
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1716
Practice Address - Country:US
Practice Address - Phone:831-465-5440
Practice Address - Fax:831-462-2017
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA236213367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife