Provider Demographics
NPI:1689970741
Name:HARBISON, TAMARA (C PED)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:HARBISON
Suffix:
Gender:F
Credentials:C PED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 COMMERCE CT
Mailing Address - Street 2:SUITE 6
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-2464
Mailing Address - Country:US
Mailing Address - Phone:303-666-5889
Mailing Address - Fax:303-666-7991
Practice Address - Street 1:9737 GREAT HILLS TRL
Practice Address - Street 2:SUITE 240
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-6417
Practice Address - Country:US
Practice Address - Phone:512-626-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-07
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2794174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist