Provider Demographics
NPI:1568422970
Name:SHIELDS, TAMARA S (CFNP)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:S
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10899 S STATE ROAD 43
Mailing Address - Street 2:
Mailing Address - City:BROOKSTON
Mailing Address - State:IN
Mailing Address - Zip Code:47923-8403
Mailing Address - Country:US
Mailing Address - Phone:866-387-2727
Mailing Address - Fax:
Practice Address - Street 1:512 SAGAMORE PKWY W
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-1458
Practice Address - Country:US
Practice Address - Phone:317-873-6438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001447A363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200383320Medicaid
INP88474Medicare UPIN
IN146800BMedicare PIN