Healthcare Provider Details

I. General information

NPI: 1447127576
Provider Name (Legal Business Name): TAMRA MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2025
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 BERGEN ST
NEWARK NJ
07103-2425
US

IV. Provider business mailing address

70 PICKET PL
FREEHOLD NJ
07728-9538
US

V. Phone/Fax

Practice location:
  • Phone: 973-972-9000
  • Fax:
Mailing address:
  • Phone: 973-972-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15412300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: