Healthcare Provider Details

I. General information

NPI: 1841629722
Provider Name (Legal Business Name): TAMAKI ANNE HARROLD CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIA TAMAKI HARROLD FNP-C

II. Dates (important events)

Enumeration Date: 11/01/2013
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2573 STATE HWY 522
QUESTA NM
87556
US

IV. Provider business mailing address

PO BOX 290
QUESTA NM
87556-0290
US

V. Phone/Fax

Practice location:
  • Phone: 575-586-3015
  • Fax: 575-586-0519
Mailing address:
  • Phone: 575-586-0315
  • Fax: 575-586-0519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0000139-C-NP
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP02406
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: