Provider Demographics
NPI:1922033455
Name:BEEGHLY, TAMMARA SAM (PA-C)
Entity Type:Individual
Prefix:
First Name:TAMMARA
Middle Name:SAM
Last Name:BEEGHLY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 531353
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89053-1353
Mailing Address - Country:US
Mailing Address - Phone:702-248-2228
Mailing Address - Fax:702-248-2213
Practice Address - Street 1:2110 E FLAMINGO RD
Practice Address - Street 2:SUITE 104
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5190
Practice Address - Country:US
Practice Address - Phone:702-248-2228
Practice Address - Fax:702-248-2213
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NVPA0265363AM0700X
NVPA829363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVQ23369Medicare UPIN