Provider Demographics
NPI:1205023199
Name:OLSON, TAMARA CLARE (FNP)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:CLARE
Last Name:OLSON
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 1:50 S B B KING BLVD # 100
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-2626
Mailing Address - Country:US
Mailing Address - Phone:901-436-1381
Mailing Address - Fax:
Practice Address - Street 1:3900 E BRISTOL ST
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-4466
Practice Address - Country:US
Practice Address - Phone:800-635-5516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28143592A363LF0000X
KS71002496A363LF0000X
IN71002496A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000550790OtherBCBS BMG MEDPOINT
IN200899990Medicaid
IN000000635078OtherBCBS BMG CENTRAL NEIGHBORHOOD
INP00784113OtherRR MEDICARE
IN000000550637OtherBCBS MEDPOINT
IN000000550790OtherBCBS BMG MEDPOINT