Provider Demographics
NPI:1376543827
Name:JAKUBOWSKI, TAMARA LYNN (CPNP)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:LYNN
Last Name:JAKUBOWSKI
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2163 BROOKSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:FURLONG
Mailing Address - State:PA
Mailing Address - Zip Code:18925-1253
Mailing Address - Country:US
Mailing Address - Phone:215-794-7817
Mailing Address - Fax:
Practice Address - Street 1:207 LAKESIDE DRIVE
Practice Address - Street 2:SOUTHAMPTON PEDIATRICS
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966
Practice Address - Country:US
Practice Address - Phone:215-953-1020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP002054-D363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics