Provider Demographics
NPI:1740281690
Name:ANDREWS, TAMERA J (NP-C)
Entity type:Individual
Prefix:MRS
First Name:TAMERA
Middle Name:J
Last Name:ANDREWS
Suffix:
Gender:
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 W HIVELY AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46517-2191
Mailing Address - Country:US
Mailing Address - Phone:574-350-2500
Mailing Address - Fax:
Practice Address - Street 1:148 W HIVELY AVE STE 1
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46517-2191
Practice Address - Country:US
Practice Address - Phone:574-350-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704393798363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200496460Medicaid
INQ22889Medicare UPIN