Provider Demographics
NPI:1639310691
Name:ZARUBA, TAMMY (CPNP)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:
Last Name:ZARUBA
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 1:10121 BAY DR
Mailing Address - Street 2:
Mailing Address - City:WESTFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01886-4127
Mailing Address - Country:US
Mailing Address - Phone:617-901-4404
Mailing Address - Fax:978-514-6324
Practice Address - Street 1:100 HOSPITAL RD STE 4
Practice Address - Street 2:MEDICAL ASSOCIATES PEDIATRICS
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453
Practice Address - Country:US
Practice Address - Phone:978-514-6300
Practice Address - Fax:978-514-6324
Is Sole Proprietor?:No
Enumeration Date:2009-03-20
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN274124364SP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMZ0751950JOtherSTAE CONTROLLED SUBSTANCE
MARN274124OtherSTATE LICENSE