Provider Demographics
NPI:1952667636
Name:MIELOCK, TAMARA LEE (NP-C)
Entity Type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:LEE
Last Name:MIELOCK
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:414 ALICE ST
Mailing Address - Street 2:
Mailing Address - City:EAST TAWAS
Mailing Address - State:MI
Mailing Address - Zip Code:48730-1542
Mailing Address - Country:US
Mailing Address - Phone:989-305-5299
Mailing Address - Fax:
Practice Address - Street 1:1481 WEST 10TH STREET
Practice Address - Street 2:RICHARD L. ROUDEBUSH VA MEDICAL CENTER
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202
Practice Address - Country:US
Practice Address - Phone:317-988-2387
Practice Address - Fax:317-988-2130
Is Sole Proprietor?:No
Enumeration Date:2012-04-06
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704286137363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily