Provider Demographics
NPI:1740437680
Name:LOVE, TAMARA R (NP)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:R
Last Name:LOVE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:TAMARA
Other - Middle Name:R
Other - Last Name:ZULEWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:205 PAGE RD
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8798
Mailing Address - Country:US
Mailing Address - Phone:910-295-5511
Mailing Address - Fax:
Practice Address - Street 1:1413 GREENWAY CT
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-6954
Practice Address - Country:US
Practice Address - Phone:919-292-1201
Practice Address - Fax:919-292-1205
Is Sole Proprietor?:No
Enumeration Date:2008-08-22
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA160167363L00000X
NC5005299363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7005066Medicaid
NCFH4001260OtherFIRST MEDICARE DIRECT
NCFH4001260OtherFIRST CAROLINA CARE, INC
NC7005066Medicaid