Provider Demographics
NPI:1598056087
Name:SCHMID, TANDRA NICOLE (ANP)
Entity Type:Individual
Prefix:
First Name:TANDRA
Middle Name:NICOLE
Last Name:SCHMID
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5119 NE 57TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97218-2584
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5119 NE 57TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97218-2584
Practice Address - Country:US
Practice Address - Phone:503-215-8050
Practice Address - Fax:503-215-8082
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201150034NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR168395Medicaid
OR381846Medicare Oscar/Certification
OR381846Medicare Oscar/Certification
ORR103163OtherMEDICARE PART B