Provider Demographics
NPI:1497908032
Name:MADJID, TAMARA L (APRN)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:L
Last Name:MADJID
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 S YALE AVE
Mailing Address - Street 2:SUITE 1400
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3347
Mailing Address - Country:US
Mailing Address - Phone:918-488-6001
Mailing Address - Fax:
Practice Address - Street 1:10505 E 91ST ST
Practice Address - Street 2:SUITE 203
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5801
Practice Address - Country:US
Practice Address - Phone:918-382-5399
Practice Address - Fax:918-382-5704
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0078685363LW0102X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK78685OtherSTATE LICENSE
OK200218440AMedicaid