Provider Demographics
NPI:1013108364
Name:KIRBY, TAMARA LOUISE (LVN)
Entity type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:LOUISE
Last Name:KIRBY
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:LOUISE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:125 W MISSION AVE
Mailing Address - Street 2:103
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-1720
Mailing Address - Country:US
Mailing Address - Phone:760-747-3424
Mailing Address - Fax:760-747-3435
Practice Address - Street 1:125 W MISSION AVE
Practice Address - Street 2:103
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-1720
Practice Address - Country:US
Practice Address - Phone:760-747-3424
Practice Address - Fax:760-747-3435
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN119769164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse