Provider Demographics
NPI:1811726318
Name:ROSHAY, TAMARA
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:ROSHAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1185 W UNIVERSITY AVE UNIT 214
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-7150
Mailing Address - Country:US
Mailing Address - Phone:415-265-7113
Mailing Address - Fax:
Practice Address - Street 1:930 N SWITZER CANYON DR STE 103
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-4834
Practice Address - Country:US
Practice Address - Phone:928-637-6406
Practice Address - Fax:844-772-0459
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-01
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ310252363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily