Provider Demographics
NPI:1013789122
Name:DUPUIS, TAMARA ANN
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:ANN
Last Name:DUPUIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1851 STEAMBOAT PKWY UNIT 5902
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-6352
Mailing Address - Country:US
Mailing Address - Phone:831-331-9494
Mailing Address - Fax:
Practice Address - Street 1:1100 TRANCAS ST STE 270
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-2921
Practice Address - Country:US
Practice Address - Phone:707-252-1076
Practice Address - Fax:707-252-4764
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2025-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA536184363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics