Provider Demographics
NPI:1356401517
Name:HALL, TAMARA C (RN ACNP)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:C
Last Name:HALL
Suffix:
Gender:F
Credentials:RN ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 535
Mailing Address - Street 2:
Mailing Address - City:BURGESS
Mailing Address - State:VA
Mailing Address - Zip Code:22432-0535
Mailing Address - Country:US
Mailing Address - Phone:804-453-7517
Mailing Address - Fax:
Practice Address - Street 1:86 HARRIS DR.
Practice Address - Street 2:
Practice Address - City:KILMARNOCK
Practice Address - State:VA
Practice Address - Zip Code:22482
Practice Address - Country:US
Practice Address - Phone:804-435-2651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165987207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024165987OtherNP LICENSE
VAP00480084OtherRR MEDICARE
VAQ76722Medicare UPIN
VA0024165987OtherNP LICENSE