Provider Demographics
NPI:1457867517
Name:MCDONALD, TAMARA KAY (NP)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:KAY
Last Name:MCDONALD
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 1:8602 E VALLEY VISTA DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-5830
Mailing Address - Country:US
Mailing Address - Phone:602-881-2534
Mailing Address - Fax:
Practice Address - Street 1:8602 E VALLEY VISTA DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85250-5830
Practice Address - Country:US
Practice Address - Phone:602-881-2534
Practice Address - Fax:602-881-2534
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-26
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP10705363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty