Provider Demographics
NPI:1780168179
Name:PINARD, TAMARA R (PMHNP)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:R
Last Name:PINARD
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:R
Other - Last Name:TASSY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:81 LOUDEN AVE
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-2736
Mailing Address - Country:US
Mailing Address - Phone:631-789-7421
Mailing Address - Fax:
Practice Address - Street 1:81 LOUDEN AVE
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2736
Practice Address - Country:US
Practice Address - Phone:631-789-7421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-20
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY98572163W00000X
NY403839363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse