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NPI Code Detail

MEDICARE: MRS. TAMARA BOYD POTTILLO

MEDICARE: MRS. TAMARA BOYD POTTILLO
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
1363LP0808XPsychiatric/Mental Health Nurse PractitionerTPAN1705FL
2363LP0808XPsychiatric/Mental Health Nurse PractitionerR197825MD
3363LP0808XPsychiatric/Mental Health Nurse PractitionerL8-0010590DE

General Provider Information

NPI Number : 1922717495
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TAMARA BOYD POTTILLO
Provider Business Mailing Address
First Line : 1301 YORK RD STE 800
Second Line :
City : LUTHERVILLE TIMONIUM
State : MD
Zip : 21093-6011
Country : US
Telephone Number : 410-376-8728
Fax Number : 410-862-3774
Provider Business Practice Location Address
First Line : 1301 YORK RD STE 800
Second Line :
City : LUTHERVILLE TIMONIUM
State : MD
Zip : 21093-6011
Country : US
Telephone Number : 410-376-8728
Fax Number : 410-862-3774
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/23/2022
Last Update Date : 12/13/2025

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Directions to “ MRS. TAMARA BOYD POTTILLO ” Practice Location

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