Provider Demographics
NPI:1154439891
Name:ROBERTSON, TAMARA M (FNP)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:M
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 CORNERSTONE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242
Mailing Address - Country:US
Mailing Address - Phone:731-642-8884
Mailing Address - Fax:731-642-8865
Practice Address - Street 1:1002 CORNERSTONE DR
Practice Address - Street 2:SUITE A
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242
Practice Address - Country:US
Practice Address - Phone:731-642-8884
Practice Address - Fax:731-642-8865
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000096778363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3701995Medicaid
TN3701995Medicaid
TN3903304Medicare ID - Type Unspecified