Provider Demographics
NPI:1760910301
Name:BRUSKI, TAMARA ANN
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:ANN
Last Name:BRUSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1776 S JACKSON ST STE 704
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-3806
Mailing Address - Country:US
Mailing Address - Phone:720-412-9648
Mailing Address - Fax:
Practice Address - Street 1:1776 S JACKSON ST STE 704
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-3806
Practice Address - Country:US
Practice Address - Phone:720-412-9648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0012813305R00000X, 302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
No305R00000XManaged Care OrganizationsPreferred Provider Organization