Healthcare Provider Details

I. General information

NPI: 1831537380
Provider Name (Legal Business Name): TAMARA MARIE AMENDT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMARA MARIE OSTBY

II. Dates (important events)

Enumeration Date: 06/06/2013
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 6TH AVENUE NORTH CENTRACARE CLINIC RIVER CAMPUS HEART AND VASCULAR CENTE
ST CLODU MN
56303-2735
US

IV. Provider business mailing address

1200 6TH AVENUE NORTH CENTRACARE CLINIC RIVER CAMPUS HEART AND VASCULAR CENTE
ST CLOUD MN
56303-2735
US

V. Phone/Fax

Practice location:
  • Phone: 320-656-7020
  • Fax: 320-255-5943
Mailing address:
  • Phone: 320-656-7020
  • Fax: 320-255-5943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number11327
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1902
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: