Provider Demographics
NPI:1467495002
Name:GRISSELL, TAMARA MELISSA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:MELISSA
Last Name:GRISSELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:10 EMPIRE STATE BLVD
Mailing Address - Street 2:
Mailing Address - City:CASTLETON
Mailing Address - State:NY
Mailing Address - Zip Code:12033-9751
Mailing Address - Country:US
Mailing Address - Phone:518-479-6837
Mailing Address - Fax:518-479-6849
Practice Address - Street 1:10 EMPIRE STATE BLVD
Practice Address - Street 2:
Practice Address - City:CASTLETON
Practice Address - State:NY
Practice Address - Zip Code:12033-9751
Practice Address - Country:US
Practice Address - Phone:518-479-6837
Practice Address - Fax:518-479-6849
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2283141363LF0000X
NYF333342363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily