Healthcare Provider Details

I. General information

NPI: 1790219665
Provider Name (Legal Business Name): TAMARA ANNETTE HUFFORD RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2017
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2788 CHATHAM DR
TROY OH
45373-8247
US

IV. Provider business mailing address

2788 CHATHAM DR
TROY OH
45373-8247
US

V. Phone/Fax

Practice location:
  • Phone: 937-418-9826
  • Fax:
Mailing address:
  • Phone: 937-418-9826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN265752
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: