Healthcare Provider Details

I. General information

NPI: 1255244364
Provider Name (Legal Business Name): TAMARA LYNN TOSCAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7004 W POPLAR ST
BOISE ID
83704-7431
US

IV. Provider business mailing address

7004 W POPLAR ST
BOISE ID
83704-7431
US

V. Phone/Fax

Practice location:
  • Phone: 986-268-9641
  • Fax:
Mailing address:
  • Phone: 986-268-9641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: