Provider Demographics
NPI:1740816289
Name:POBOCIK, TAMARA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:POBOCIK
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7227 FENTON RD
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-8961
Mailing Address - Country:US
Mailing Address - Phone:810-771-4074
Mailing Address - Fax:
Practice Address - Street 1:15173 NORTH RD STE 100
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-1381
Practice Address - Country:US
Practice Address - Phone:810-771-4074
Practice Address - Fax:810-866-4450
Is Sole Proprietor?:No
Enumeration Date:2020-03-17
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704177017363LP0808X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse