Provider Demographics
NPI:1336477728
Name:BRUNK, TAMARA RAE (APRN-CNS)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:RAE
Last Name:BRUNK
Suffix:
Gender:F
Credentials:APRN-CNS
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:
Other - Last Name:MEIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-CNS
Mailing Address - Street 1:1115 WALNUT DR
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-2354
Mailing Address - Country:US
Mailing Address - Phone:580-223-7472
Mailing Address - Fax:580-223-6673
Practice Address - Street 1:1115 WALNUT DR
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-2354
Practice Address - Country:US
Practice Address - Phone:580-223-7472
Practice Address - Fax:580-223-6673
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK83324364SC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SC0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCritical Care Medicine