Provider Demographics
NPI:1487675070
Name:BRUNKER, TAMARA M (PA-C)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:M
Last Name:BRUNKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 SPRUCE ST
Mailing Address - Street 2:9 FOUNDERS
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4206
Mailing Address - Country:US
Mailing Address - Phone:215-662-7355
Mailing Address - Fax:215-349-8444
Practice Address - Street 1:3400 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4206
Practice Address - Country:US
Practice Address - Phone:215-662-7355
Practice Address - Fax:215-349-8444
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMP000369363AM0700X
PAMA001291L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
43877OtherUNIVERSITY HEALTH PLAN
3K5950OtherHEALTHNET
NJ105681 AVVMedicare PIN