MEDICARE: TAMARA HEAD RN, APRN-CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	1113001	TX

General Provider Information

NPI Number	:	1225730526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMARA HEAD RN, APRN-CNP

Provider Business Mailing Address
First Line	:	104 FOSSIL WAY
Second Line	:
City	:	ALVARADO
State	:	TX
Zip	:	76009-2659
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 O CONNOR RIDGE BLVD STE 100
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75038-6513
Country	:	US
Telephone Number	:	214-300-8331
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2023
Last Update Date	:	03/20/2023

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