Provider Demographics
NPI:1750881199
Name:TAMARA B. DESVARIEUX, ADULT NURSE PRACTITIONER,P.C.
Entity type:Organization
Organization Name:TAMARA B. DESVARIEUX, ADULT NURSE PRACTITIONER,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:BARBARA
Authorized Official - Last Name:DESVARIEUX
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:516-778-1736
Mailing Address - Street 1:95 PEARSALL AVE
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-1542
Mailing Address - Country:US
Mailing Address - Phone:516-778-1736
Mailing Address - Fax:
Practice Address - Street 1:245 CONKLIN ST
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-2659
Practice Address - Country:US
Practice Address - Phone:516-778-1736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-12
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF305723363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty