Provider Demographics
NPI:1871010736
Name:SMITH, TAMARA Y (NP)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:Y
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1595 N CENTRAL AVE APT 39
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-1186
Mailing Address - Country:US
Mailing Address - Phone:516-284-7521
Mailing Address - Fax:516-475-2600
Practice Address - Street 1:76 S CENTRAL AVE STE 1A
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5405
Practice Address - Country:US
Practice Address - Phone:516-284-7521
Practice Address - Fax:516-475-2600
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2024-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY654591163W00000X
NY308468363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health