Provider Demographics
NPI:1548612195
Name:MCGILLIN, TAMARA (CPNP)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:MCGILLIN
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 1:1103 MACBETH CT
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-1573
Mailing Address - Country:US
Mailing Address - Phone:240-812-2167
Mailing Address - Fax:302-368-8836
Practice Address - Street 1:4735 OGLETOWN STANTON RD
Practice Address - Street 2:M.A.P. #2, SUITE 1116
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2072
Practice Address - Country:US
Practice Address - Phone:302-368-8612
Practice Address - Fax:302-368-8836
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELJ-0000312363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics