Healthcare Provider Details

I. General information

NPI: 1255587804
Provider Name (Legal Business Name): TAMI R SWEAZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2008
Last Update Date: 08/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 JACKSON ST SW
CAMDEN AR
71701-3941
US

IV. Provider business mailing address

715 N COLLEGE AVE
EL DORADO AR
71730-4403
US

V. Phone/Fax

Practice location:
  • Phone: 870-836-5743
  • Fax: 870-836-6924
Mailing address:
  • Phone: 870-862-7921
  • Fax: 870-864-2490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberL34019
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: