Healthcare Provider Details

I. General information

NPI: 1962965640
Provider Name (Legal Business Name): TAMARA PHOEBUS APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2019
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1261 ROUTE 38 STE A
HAINESPORT NJ
08036-2702
US

IV. Provider business mailing address

1261 ROUTE 38 STE A
HAINESPORT NJ
08036-2702
US

V. Phone/Fax

Practice location:
  • Phone: 856-222-1975
  • Fax:
Mailing address:
  • Phone: 856-222-1975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ00915800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: