Provider Demographics
NPI:1881391480
Name:MCMILLAN, TAMARA SELINA (MSN, RN, AGACNP-BC)
Entity type:Individual
Prefix:MISS
First Name:TAMARA
Middle Name:SELINA
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:MSN, RN, AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1391 E MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-8568
Mailing Address - Country:US
Mailing Address - Phone:619-444-1107
Mailing Address - Fax:
Practice Address - Street 1:1391 E MADISON AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-8568
Practice Address - Country:US
Practice Address - Phone:619-444-1107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95023081363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner