Provider Demographics
NPI:1851168132
Name:FREITAS, TAMARA LEE
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:LEE
Last Name:FREITAS
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 1:20 HIGH RIDGE TER
Mailing Address - Street 2:
Mailing Address - City:TIVERTON
Mailing Address - State:RI
Mailing Address - Zip Code:02878-1600
Mailing Address - Country:US
Mailing Address - Phone:774-264-0131
Mailing Address - Fax:
Practice Address - Street 1:20 HIGH RIDGE TER
Practice Address - Street 2:
Practice Address - City:TIVERTON
Practice Address - State:RI
Practice Address - Zip Code:02878-1600
Practice Address - Country:US
Practice Address - Phone:774-264-0131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2279215363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily