Provider Demographics
NPI:1891023529
Name:FISCHER, TAMARA L (NP)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:L
Last Name:FISCHER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7436 E MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-9338
Mailing Address - Country:US
Mailing Address - Phone:480-325-9600
Mailing Address - Fax:480-493-5336
Practice Address - Street 1:1000 WILLOW CREEK RD STE D
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1645
Practice Address - Country:US
Practice Address - Phone:480-325-9600
Practice Address - Fax:480-493-5336
Is Sole Proprietor?:No
Enumeration Date:2009-11-18
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA090940363LF0000X
NE111725363LA2200X, 363LF0000X, 363LP2300X
MO2010001473363LF0000X
AZAP10966363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO787000012OtherMEDICARE PTAN NUMBER