Provider Demographics
NPI:1093506958
Name:DAVYDOVA, TAMARA (FNP-BC, WCC, OMS)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:DAVYDOVA
Suffix:
Gender:F
Credentials:FNP-BC, WCC, OMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14404 69TH RD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1702
Mailing Address - Country:US
Mailing Address - Phone:347-656-3730
Mailing Address - Fax:
Practice Address - Street 1:14404 69TH RD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1702
Practice Address - Country:US
Practice Address - Phone:347-656-3730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-13
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY620695163WW0000X, 163WX1500X
NYF355879-07363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
No163WX1500XNursing Service ProvidersRegistered NurseOstomy Care
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care