Provider Demographics
NPI:1588833610
Name:EDELKIND, TAMAR H (PNP PEDIACTRIC NURSE)
Entity Type:Individual
Prefix:
First Name:TAMAR
Middle Name:H
Last Name:EDELKIND
Suffix:
Gender:F
Credentials:PNP PEDIACTRIC NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 ROSELAND AVE
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06710-1494
Mailing Address - Country:US
Mailing Address - Phone:203-574-4747
Mailing Address - Fax:
Practice Address - Street 1:179 ROSELAND AVE
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06710-1494
Practice Address - Country:US
Practice Address - Phone:203-574-4747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-22
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002014363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics