Provider Demographics
NPI:1831537380
Name:AMENDT, TAMARA MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:MARIE
Last Name:AMENDT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:MARIE
Other - Last Name:OSTBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 6TH AVENUE NORTH
Mailing Address - Street 2:CENTRACARE CLINIC RIVER CAMPUS HEART AND VASCULAR CENTE
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-2735
Mailing Address - Country:US
Mailing Address - Phone:320-656-7020
Mailing Address - Fax:320-255-5943
Practice Address - Street 1:1200 6TH AVENUE NORTH
Practice Address - Street 2:CENTRACARE CLINIC RIVER CAMPUS HEART AND VASCULAR CENTE
Practice Address - City:ST CLODU
Practice Address - State:MN
Practice Address - Zip Code:56303-2735
Practice Address - Country:US
Practice Address - Phone:320-656-7020
Practice Address - Fax:320-255-5943
Is Sole Proprietor?:No
Enumeration Date:2013-06-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1902363AS0400X
MN11327363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical