Healthcare Provider Details

I. General information

NPI: 1992371975
Provider Name (Legal Business Name): TAMARA ROYALTY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TAMARA SIMMONS FNP-C

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4152 W STATE ROAD 56
HANOVER IN
47243-9070
US

IV. Provider business mailing address

PO BOX 776351
CHICAGO IL
60677-6351
US

V. Phone/Fax

Practice location:
  • Phone: 812-762-4510
  • Fax:
Mailing address:
  • Phone: 502-588-9490
  • Fax: 502-272-5116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71017339A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3016147
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: