Provider Demographics
NPI:1952679086
Name:ALTSTATT, TAMARA (APRN)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:ALTSTATT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5721 NW 132ND ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-4437
Mailing Address - Country:US
Mailing Address - Phone:405-557-1200
Mailing Address - Fax:405-557-1977
Practice Address - Street 1:5721 NW 132ND ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-4437
Practice Address - Country:US
Practice Address - Phone:405-557-1200
Practice Address - Fax:405-557-1977
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-03
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK60575363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health