Provider Demographics
NPI:1982331385
Name:BALCERZAK, TAMARA (FNP-C)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:BALCERZAK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:
Other - Last Name:BOZIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:863 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1643
Mailing Address - Country:US
Mailing Address - Phone:224-601-6863
Mailing Address - Fax:
Practice Address - Street 1:863 N MILWAUKEE AVE UNIT 400
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1643
Practice Address - Country:US
Practice Address - Phone:224-601-6863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209025502363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily