Provider Demographics
NPI:1891489027
Name:CARLISLE, TAMARA SUE
Entity Type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:SUE
Last Name:CARLISLE
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 1:2148 HANBY SQ N
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-2807
Mailing Address - Country:US
Mailing Address - Phone:740-513-0758
Mailing Address - Fax:
Practice Address - Street 1:2148 HANBY SQ N
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-2807
Practice Address - Country:US
Practice Address - Phone:740-513-0758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker