Healthcare Provider Details

I. General information

NPI: 1811083546
Provider Name (Legal Business Name): TAMARA LEE TAYLOR-HESS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMARA BLANK PA-C

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2817 ROCK MERRITT AVE
FORT BRAGG NC
28310-0001
US

IV. Provider business mailing address

2817 ROCK MERRITT AVE
FORT BRAGG NC
28310-0001
US

V. Phone/Fax

Practice location:
  • Phone: 910-907-8922
  • Fax: 910-907-6069
Mailing address:
  • Phone: 910-907-8922
  • Fax: 910-907-6069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0010-16587
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10000435A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA2014-0063
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA16004
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: