Provider Demographics
NPI:1003229782
Name:YOUNGBLOOD, TAMERA ANN (ACNP)
Entity type:Individual
Prefix:MRS
First Name:TAMERA
Middle Name:ANN
Last Name:YOUNGBLOOD
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:TAMERA
Other - Middle Name:ANN
Other - Last Name:QUERREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14570 E SWEETWATER AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-4633
Mailing Address - Country:US
Mailing Address - Phone:602-463-8064
Mailing Address - Fax:800-877-0713
Practice Address - Street 1:14570 E SWEETWATER AVE
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-4633
Practice Address - Country:US
Practice Address - Phone:602-463-8064
Practice Address - Fax:800-877-0713
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COC-APN.0101910-C-NP363LA2100X
NM78549363LA2100X
AZAP5670363LA2100X
AZRN140562163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse