Healthcare Provider Details

I. General information

NPI: 1750919635
Provider Name (Legal Business Name): TAMARA QUISETTE DUDLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3802 BISCAYNE HILLS DR
NORTHPORT AL
35473-2437
US

IV. Provider business mailing address

3802 BISCAYNE HILLS DR
NORTHPORT AL
35473-2437
US

V. Phone/Fax

Practice location:
  • Phone: 205-292-8555
  • Fax:
Mailing address:
  • Phone: 205-657-9522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-118454
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: