Provider Demographics
NPI:1932262417
Name:HOWARD-FAIN, TAMARA (APRN, BC)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:HOWARD-FAIN
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2245 S LAUDERDALE ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38106-7517
Mailing Address - Country:US
Mailing Address - Phone:901-948-5558
Mailing Address - Fax:901-774-9031
Practice Address - Street 1:2245 S LAUDERDALE ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38106-7517
Practice Address - Country:US
Practice Address - Phone:901-948-5558
Practice Address - Fax:901-774-9031
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN117022163W00000X
TN7672363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ35984Medicare UPIN
TN3648150Medicare PIN