Healthcare Provider Details

I. General information

NPI: 1669733648
Provider Name (Legal Business Name): TAMARA HASLAR F.N.P
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 06/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8111 S EMERSON AVE
INDIANAPOLIS IN
46237-8601
US

IV. Provider business mailing address

8111 S EMERSON AVE
INDIANAPOLIS IN
46237-8601
US

V. Phone/Fax

Practice location:
  • Phone: 317-528-8013
  • Fax:
Mailing address:
  • Phone: 317-528-8013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28127613A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number28127613A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: