Provider Demographics
NPI:1942697347
Name:JOE, TAMBA
Entity Type:Individual
Prefix:
First Name:TAMBA
Middle Name:
Last Name:JOE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14421 INNSBRUCK CT
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-2256
Mailing Address - Country:US
Mailing Address - Phone:240-779-6990
Mailing Address - Fax:
Practice Address - Street 1:14421 INNSBRUCK CT
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-2256
Practice Address - Country:US
Practice Address - Phone:240-779-6990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-23
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide