Provider Demographics
NPI:1457985913
Name:KNIGHT, TAMMARA L (RN)
Entity Type:Individual
Prefix:MS
First Name:TAMMARA
Middle Name:L
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 PALO VERDE BLVD S
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-4919
Mailing Address - Country:US
Mailing Address - Phone:928-854-5351
Mailing Address - Fax:928-854-5387
Practice Address - Street 1:2675 PALO VERDE BLVD S
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-4919
Practice Address - Country:US
Practice Address - Phone:928-854-5351
Practice Address - Fax:928-854-5387
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN178480163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse