Provider Demographics
NPI:1972271799
Name:CRISPIN, TAMARA (RN)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:CRISPIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1413 FAIRBANKS DR
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-1623
Mailing Address - Country:US
Mailing Address - Phone:352-988-4708
Mailing Address - Fax:
Practice Address - Street 1:1413 FAIRBANKS DR
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-1623
Practice Address - Country:US
Practice Address - Phone:352-988-4708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-06
Last Update Date:2021-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9246869163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy