Provider Demographics
NPI:1740621838
Name:BROUSSARD, TAMAR MICHELLE (PA, MPH)
Entity type:Individual
Prefix:
First Name:TAMAR
Middle Name:MICHELLE
Last Name:BROUSSARD
Suffix:
Gender:F
Credentials:PA, MPH
Other - Prefix:
Other - First Name:TAMAR
Other - Middle Name:MICHELLE
Other - Last Name:HEMME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8233 E STOCKTON BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95828-8203
Mailing Address - Country:US
Mailing Address - Phone:916-368-3080
Mailing Address - Fax:
Practice Address - Street 1:8233 E STOCKTON BLVD STE D
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95828-8203
Practice Address - Country:US
Practice Address - Phone:916-368-3080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2023-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA23022363A00000X
PAMA060105363AM0700X
NJ25MP00492300363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical