Provider Demographics
NPI:1891749156
Name:BAINES, TAMAHRA M (APNP)
Entity Type:Individual
Prefix:MRS
First Name:TAMAHRA
Middle Name:M
Last Name:BAINES
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:MS
Other - First Name:TAMARA
Other - Middle Name:H
Other - Last Name:LANGHOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP
Mailing Address - Street 1:7974 UW HEALTH CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1102 S PARK ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1708
Practice Address - Country:US
Practice Address - Phone:608-282-8270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1592363LP0200X, 363LP0808X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39945600Medicaid
002006261VOtherHUMANA
P05491Medicare UPIN
WI73601 1363Medicare PIN